absenteeism in the gauteng department of health by cynthia siziwe ndhlovu
TRANSCRIPT
ABSENTEEISM IN THE GAUTENG DEPARTMENT OF HEALTH
By
Cynthia Siziwe Ndhlovu
Submitted in partial fulfillment of the requirements for the Degree of
Master in Public Administration at the University of South Africa (UNISA)
Supervisor Professor S B Kahn
Joint supervisor Mr A Van Schalkwyk
JUNE 2012
DECLARATION
I declare that Absenteeism in the Gauteng Department of Health is my own work and that
all the resources that I have used or quoted have been indicated and acknowledged by
means of complete references
Name C S Ndhlovu
Studentnumber 0-417-427-5
Date 11 June 2012
Signature ----------------------------------
II
ABSTRACT
The research is a quantitative descriptive survey The sample is a stratified random sampling
of the workforce (n=4010) of the four hospitals in Gauteng that fall under the jurisdiction of
Tshwane Ekurhuleni and Johannesburg Metropolitan Councils The research examines the
extent of the impact of age gender occupation salary level tenure and race on workplace
absenteeism The data were collected in three phases involving auditing of hard copy files
structured interviews and information technology system
The findings of the research reflect high workplace absenteeism in females by 832 age
group between 45 to 49 years by 2235 salary range of 2 to 3 by 353 African race group
by 963 tenure of 11 to 20 years by 443 nurses by 208 and administration support by
354 The research found that the mature employee in age and of higher year of tenure
presented comparatively with lower rate of absenteeism
Key words
Workplace absenteeism workplace absenteeism employee abscondment and desertion
employment relationships leave cycle quality standard
III
ACKNOWLEDGEMENTS
This work is dedicated to my late son Neville Ndhlovu my loving husband Errol Ndhlovu
who has been my pillar of strength my son John Ndhlovu for the unwavering
encouragement throughout this tough journey my nuclear family without whose support
during the grieving period I would not have completed this research I would like to
acknowledge my daughter-in-law Vuyelwa Ndhlovu and my lovely grandchildren Nhlamulo
and Ntsako Ndhlovu who are the sunshine of my life who allowed me to work on
ldquoProfessorrsquos workrdquo as they referred to the research I thank God who made it possible for
me to stay on track during the darkest hour in my life
I wish to extend my sincere gratitude to Professor Pauw who believed in me my
supervisor Professor S B Kahn who remained a beacon of hope during the most trying time
in my life Professor S B Kahn and my joint supervisor Mr A Van Schalkwyk offered valuable
professional guidance that ensured that the research met the required academic standard
I wish to extend my sincere gratitude to Mrs Marti Gerber who dedicated herself editing
this document
I am aware that there are others who also assisted in different ways whom I might have
omitted to mention in my acknowledgement who made it possible for me to complete the
task at hand The quality of your efforts and assistance is evident in the final product May
God bless you all in your generous efforts towards completion of this research
IV
GLOSSARY
ANC = African National Congress
BCEA=Basic Conditions of Employment
CNA=Canadian Nurses Association
CAT= Catastrophic Model
CIPD= Charted Institute of Personnel Development
CCMA = Commission for Conciliation Mediation and Arbitration
CSRS=Civil Service Retirement System
DPSA=Department of Public Service and Administration
EAP= Employee Assistance Programme
EFILWC=European Foundation for the Improvement of Living and Working Conditions
FERS=Federal Employees Retirement System
GDoH=Gauteng Department of Health
GHP=Gross Health Product
HRIM=Human Resource Information Management
HRDS=Human Resource Development Strategy
RSA=Republic of South Africa
PILIR=Policy and Procedures on Incapacity Leave for Ill-Health Retirement
PERSAL= Personnel Remuneration Administration System
PSCBC=Public ServiceCo-ordinating Bargaining Council
PTO= Paid Time off Model
PSC= Public Service Commission
SACOB=South African Chamber of Business
V
Table of Contents
1 CHAPTER 1 GENERAL INTRODUCTION 1
11 INTRODUCTION 1
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH 1
13 PROBLEM STATEMENT 2
14 AIM AND OBJECTIVES OF THE RESEARCH 2
141 Aim 2
142 Objectives 2
15 LITERATURE REVIEW 3
16 TERMINOLOGY 3
17 RESEARCH DESIGN AND METHODOLOGY 4
171 Research design 4
172 Methodology 5
173 Unit of analysis 7
174 Unit of observation 7
18 CONSTRUCT VALIDITY 7
19 ETHICAL CONSIDERATION 7
110 LIMITATIONS OF THE RESEARCH 8
111 STRUCTURE OF THE RESEARCH 8
112 REFERENCE TECHNIQUEhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip9
113 CONCLUSION 9
2 CHAPTER 2 MANAGING ABSENTEEISM 10
21 INTRODUCTION 10
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM 10
221 Classification of absenteeism 15
222 Definition of key concepts 15
23 EMPLOYMENT RELATIONSHIPS 17
231 Employment relationship as a multi-dimensional phenomenon 17
2311 Economic dimensions 17
2312 Legal dimension 18
2313 Individual dimension 18
2314 Collective dimension 19
2315 Psycho-social dimension 19
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM 19
25 PREDICTORS OF ABSENTEEISM 20
26 A MULTI-GROUP INVARIANCE MODEL 22
27 CATASTROPHIC MODEL (CAT) 24
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM 24
VI
281 Measuring absenteeism 25
29 IMPACT OF WORKPLACE ABSENTEEISM 25
291 Cost to the institution 26
292 Low productivity 27
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM 27
2101 Effective communication 28
2102 Empowerment of managers 28
2103 Monitoring of workplace absenteeism 29
2104 Visits to facilities 30
2105 Incentive system 30
2106 Team support 31
2107 Return-to-work interviews 31
2108 Employee assistance programme (EAP) 32
2109 Occupational and safety committee 32
21010 Review committeehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip33
211 CONCLUSION 33
3 CHAPTER 3 METHODOLOGY IN RESEARCH 34
31 INTRODUCTION 34
32 RESEARCH DESIGN 34
321 Methodology 34
33 UNIT OF ANALYSIS 36
34 UNIT OF OBSERVATIONS 36
35 CONSTRUCT VALIDITY 36
36 ETHICAL CONSIDERATIONS 37
37 CONCLUSION 37
4 CHAPTER 4 INTERPRETATION AND ANALYSIS OF DATA 38
41 INTRODUCTION 38
42 THE STRUCTURE OF THE ORGANISATION 38
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY 39
44 COMPARISON OF HOSPITALS PERMANENT EMPLOYEES 40
441 The Tara Moross Centre Hospital 46
442 The Germiston Hospital 46
443 The ODI District Hospital 46
444 The George Mukhari Hospital 46
45 RESEARCH INTERPRETATION 47
451 Occupational groups in relation to absenteeism 49
4511 Doctors 50
4512 Professional nurses 51
4513 Staff nurses 51
VII
4514 Nursing assistants 51
4515 Finance officers 52
4516 Administration staff 52
4517 Administration support 52
452 Race in relation to absenteeism 57
4521 Africans 57
4522 Whites 57
4523 Coloureds 57
4524 Indians 58
453 Tenure range in relation to absenteeism 59
454 Salary range in relation to absenteeism 60
455 Age of full time employees in relation to absenteeism 61
456 Gender in relation to absenteeism 63
457 Week days in relation to occupational groups 64
46 CONCLUSION 66
5 CHAPTER 5 FINDINGS CONCLUSIONS AND RECOMMENDATIONS 67
51 INTRODUCTION 67
52 FINDINGS 67
53 CONCLUSIONS 71
54 RECOMMENDATIONS 72
BIBLIOGRAPHY 74
ANNEXURES A B Chelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip82
VIII
LIST OF FIGURES
FIGURE 21 CONCEPTUAL FRAMEWORK MODELhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
FIGURE 22 MODEL SPECIFICATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
FIGURE 41 INTEGRATED ORGANISATIONAL STRUCTUREhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip53
AS REPRESENTED BY THE HOSPITALS
FIGURE 44 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip58
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip60
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip61
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALShelliphelliphelliphelliphellip62
FIGURE 48 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip64
X
LIST OF TABLES
Table 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
Table 2 COMPARISONS OF NUMBERS OF ADMINISTRATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
AND SUPPORT STAFF IN THE DIFFERENT HOSPITALS
Table 3 GENDER COMPARISON IN DIFFERENT HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Table 4 COMPARISON OF TENURE OF SERVICE IN RELATION TOhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
ABSENTEEISM IN THE FOUR HOSPITALS
Table 5 COMPARISON OF THE OCCUPATIONAL GROUPShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip45
IN THE DIFFERENT HOSPITALS
Table 6 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip48
Table 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Table 8 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip54
(SALARY RANGE 1-12)
Table 9 AGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip55
Table 10 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Table 11 WEEK DAYS IN RELATION TO ABSENTEEISM INhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip65
THE FOUR HOSPITALS
Table 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphellip66
IX
CHAPTER 1
GENERAL INTRODUCTION
11 INTRODUCTION
The Gauteng Province is viewed as a province of opportunities by South Africans as well the
neighbouring countries such as Mozambique and Zimbabwe The impact of these
perceptions has placed a heavy demand on services including health provided within the
confines of the province the results being an increase in the workload of the employees
The indirect results of the increase in the workload have been unacceptably high levels of
absenteeism seemingly sub-standard levels of health care and high cost of delivering the
health care services Absenteeism poses a threat and can lead to the collapse of health care
services if absenteeism is poorly managed The research examines the management and
control of absenteeism in four out of thirty four hospitals that service the province The
hospitals that have been targeted for the research are ODI District Hospital Germiston
Hospital TARA Moross Centre Hospital and George Mukhari Hospital
This chapter explains the background and motivation for the research The research
highlights the problem statement which focuses on the effective management of
absenteeism The objectives of the study the research methodology and structure of the
research are explained The relevant literature review was consulted for the research The
key concepts that are used in the research are conceptually defined The research design is
a descriptive stratified random survey The data that were used were collected in three
phases the unit of analysis were the employees of the Gauteng Department of Health in the
four target hospitals and the unit of observations were observations of the employees of
the four hospitals The construct of validity was achieved through using a variety of data
collection methods Ethical considerations were taken into account during the research
process Limitations of the research were imposed by the uniqueness of each of the target
hospitals The structure of the research and the reference technique is explained in this
chapter The research on absenteeism in the Gauteng Department of Health is confined to
the period of 1 January 2008 to 31 December 2008 and focused on the working-man days
lost how absenteeism is managed and employee well-being and rehabilitation
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH
The Gauteng Department of Health received a qualified report in 2008 on the control of sick
leave A performance audit was conducted by the Public Service Commission (PSC) (2002
xvi) into the information required to effectively manage sick leave in the public service
1
The research on absenteeism in Gauteng Department of Health seeks to examine the extent
of workplace absenteeism in the ODI District Hospital which is in a transitional stage from
North West to the Gauteng Province The hospital falls under Tshwane Metropolitan
Municipality and is in Region C The Germiston Hospital falls under Ekurhuleni Metropolitan
Municipality in Region B TARA Moross Centre Hospital is in Region A under the
Johannesburg Metropolitan Municipality and George Mukhari Academic Hospital is Region C
under the Tshwane Metropolitan Municipality The research seeks to examine the degree of
compliance by the four hospitals with the recommendations of the performance audit of
management of sick leave in the light of the qualified report received by the Gauteng
Department of Health (Human Resources) in 20089
13 PROBLEM STATEMENT
The Gauteng Department of Health provides health care services as the core business of the
Department The Health care services are labour intensive and high levels of absenteeism by
its employees undermine the Departmental efforts to deliver quality health care to the
people of Gauteng The problem statement therefore is to examine to what extent the
effective management of absenteeism can enhance the effectiveness of the Gauteng
Department of Health
14 AIM AND OBJECTIVES OF THE RESEARCH
The aim and objectives of the research are explained in this section
141 AIM
The aim of the research is to determine how the effective management of absenteeism can
contribute to the effective health care of Gautengrsquos communities
142 Objectives
The objectives of the study are
to determine the impact of the variables such as age gender occupational category
and salary level on workplace absenteeism
to determine whether the correlation between absenteeism levels and tenure of
service does exist
to determine trends of workplace absenteeism in different employee categories and
to establish the different challenges confronting the different hospitals in
management and control of absenteeism in terms of size complexity and location
2
15 LITERATURE REVIEW
Various studies have been conducted to examine workplace absenteeism in different fields
in government and private institutions Van Der Westhuizen (200636) research focused on
high and low combinations of job involvement and organisational commitment The
outcome was not emphatic on the findings as predictors of the turnover and absenteeism
The research noted that women are more absent from the workplace than men De Wit
(2006) focused on the nature of absenteeism the impact of absenteeism on the
organisation reasons for and causes of absenteeism and measurement of absenteeism and
the findings were not able to find a high coefficient in the test sample
Camp and Lambert (20054) found that the use of sick leave as an incentive to reduce sick
leave by the employees under the Civil Service Retirement System (CSRS) led to a reduction
of absenteeism as a result of sick leave when compared with employees who functioned
under the conditions of the Federal Employees Retirement System (FERS) who within the
same company lost the unused sick leave when they retired
Ferguson Ferguson Muedder and Fitzgerald (200138) focused on the impact of
absenteeism and cost in terms of time lost in the Total Absence Management (TAM)
concept and found that the aging employee exposes institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods of
time
Serneels Lindelow and Lievens (2008210) claim absenteeism is high among employees in
the public sector in developing countries due to a lack of accountability and a lack of
punishment for transgression
The research seeks to determine the extent of the problem of workplace absenteeism its
impact and management in the identified hospitals It seeks to establish the relationship if
any between the various variables and absenteeism such as age occupation tenure salary
level gender and race
16 TERMINOLOGY
Key concepts that are used in the research are conceptually defined however a
comprehensive concept clarification will be done in chapter 2
Workplace absenteeism Workplace absenteeism is the absence of employee at the
workplace that is defined by Du Toit and Van Der Waldt in (1998139) as the place that the
institution makes available and where officials have to perform their work
3
Workplace forms part of the internal environment for public administration in the public
service Robbins Odendaal and Roodt (200415) define absenteeism as the failure of an
employee to report for work as scheduled regardless of the reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work According to
Venter (2003267) desertion occurs when the employee leaves the place of employment
without the intention to return to work
Employee An employee is defined as any person employed in terms of the Public Service
Act 1994 irrespective of rank or position (Public Service Act 1994 Subsection 15) Todd
(20011) refers to an employee as any person excluding an independent contractor who
works for another person and is entitled to be paid for it or who in any manner assists in
carrying on or conduct the business of the employer Bendix (2000123) defines an
employee as a person in a workplace except a ldquosenior managerial employeerdquo whose status
and contract of service grants the employee the authority to represent the employer in
interactions with the workplace forum to determine policy on behalf of the employer and
make decisions which might conflict with representation of workers at the workplace
Employer An employer as an individual person who may be the employer in legal terms as
well as the organisation which is responsible for implementing Public Service human
resource management policies (RSA 1997 Section 15)
Leave cycle The Public Service Act 1994 refers to the leave cycle as 36 months employment
with the same employer
Quality Is defined as getting the best results possible within the available resources (RSA
2011)
Standard Is a statement of an expected level of quality delivery A standard reflects the
ideal performance level of a health establishment in providing quality care (RSA 2011)
17 RESEARCH DESIGN AND METHODOLOGY
This section deals with the research design and methodology
171 Research design
Research design is the overall plan for relating the conceptual problem to relevant empirical
research It is a quantitative descriptive research that involves the systematic collection of
numerical information under conditions of considerable control (Polit amp Hungler 1994
24175)
4
The choice of the research design influences subsequent research activities such as
identifying the target subjects what data to collect and how they should be collected The
research design is a descriptive stratified random survey which is concerned with
characteristics of a specific population subject at a fixed point in time for comparative
purposes The focus is on a representative sample of the relevant population It is concerned
with the accuracy of the findings and their generalisability The survey is used to gain deeper
insight of the behaviour of employees with regards to motivation satisfaction and
grievances (Babbie 199289 Ghauri Gronhaug amp Kristianslund 199527 60 Brink 199611
6 Welman Kruger amp Mitchell 200152)
172 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services Four hospitals of the thirty four health care delivery institutions have been
identified for the research
Each hospital is unique in its character in terms of specialisation of health care delivery
service The four hospitals are located in Tshwane Johannesburg and Ekurhuleni
Metropolitan Municipalities The sample is a stratified random sampling which is composed
of various clearly recognisable non-overlapping sub-populations (strata) that differ from
one another mutually in terms of variables that are a combination of more than one
variable such as age sex income level or educational level The purpose is to ensure that
every part of the population (every stratum) is represented The members of a particular
stratum are homogeneous in the population at large The sample is representative of a
population with clearly distinguishable strata with a greater degree of certainty (Babbie
199267 Brynard amp Hanekom 200544 Ghauri et al 199578 Brink 1996138 Welman amp
Kruger 200155-56 Welman et al 201061 Polit and Hungler 199518) The data were
collected in three phases
The first phase of data collection was done through auditing of hard copies of identified
personnel files representing ten files per hospital and using the tool in annexure A amp B The
forty employeesrsquo profiles were accessed through the Human Resource Information
Management system (HRIM) located in the Gauteng Department of Health Head Office The
respective employeesrsquo profiles were handed over to the human resource manager in the
respective hospitals on the morning of the audit for the human resource practitioner to
draw out the hard copy files for auditing The characteristics of the individuals that were
identified for the first phase were males and females and the different race groups The
auditing of the files was for the complete working life of the employees and not confined to
2008 only Registers that are used by the human resource administration to control the
movement of the leave forms were inspected as evidence of the control system in place
5
The purpose of auditing the files is to gain insight into how leave in general was captured
managed and controlled by the hospitals The second phase of data collection was done
through structured interviews with the four human resource managers who were directly
accountable for management and control of leave of absence in general in the four
hospitals
A structured interview provides for a more organised approach and a more stable basis for
assessment of the different candidates (Erasmus Swanepoel Schenk Van der Westhuizen amp
Wessels 2005250) The structured interview was conducted using the tool in annexure C
Tara Moross Centre Hospital had been functioning without a manager in human resource
and the manager that was interviewed had been in the post for three months The human
resource practitioner who was at salary level 8 acting in the Assistant Directorrsquos post
(manager) was invited to join the manager and be part of the structured interview ODI
District Hospital had three human resource practitioners including the accounting officer at
level 8 and in an acting capacity
The third phase of data collection was through the Human Resource Information
Management (HRIM) This system used Personnel Remuneration Administration System
(PERSAL) to collect data Data in this system are categorised in salary level date of
appointment occupational category gender age in units of five race employing hospital
employment status in different categories such as session contract and full-time and the
different types of leave of absence
The research used primary and secondary data in analysing sick leave utilised by full time
employees in the identified hospitals for the period of 1 January to 31 December 2008 using
the Personnel Remuneration Administration System The total population sample was four
thousands and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range at level 1 to 12
The research used past events such as sick leave utilised by employees using secondary
data from Personnel Remuneration Administration System falling into the category of a
historical empirical research The interval scale of measurement was used in the
quantitative research and actual numbers are ordered with equal measurement between
each category (Brink 1996 149 Brynard amp Hanekom 2005 28-29 Mouton 2005
52100170)
6
173 Unit of analysis
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the research refers to observation of work attendance by
the employees of Gauteng Department of Health in the four hospitals
The observation deals with the historical events such as employees who have already
utilised sick leave in the workplace The subjects that are studied are the core health care
providers such as doctors nurses and support employees such as allied administration and
administration support (Mouton 200551-52 Welman et al 2001 52-53)
174 Unit of observations
The observations that are made are of health care workers and support teams in Tara
Hospital Germiston Hospital ODI Hospital and George Mukhari Hospitals The unit of
observations describes the characteristics of a large number of individual people such as
gender age salary range occupational category tenure of service and race in relation to
absenteeism in the workplace In the descriptive research the individual characteristics are
aggregated for the purpose of describing a larger group (Babbie 199292)
18 CONSTRUCT VALIDITY
Construct validity is concerned with the question what construct is the instrument actually
measuring(Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with the four accounting officers in leave management The third phase was collecting of
personnel data through the Persal system
19 ETHICAL CONSIDERATIONS
Ethical considerations included among other issues the protection of the unit of analysis and
unit of observations from discomfort and harm by not revealing information which can
cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity Anonymity is achieved
when the researcher cannot link a given response with a given respondent and reporting
aggregate data only When data are collected at one sitting and not over a period of time
makes it possible to achieve anonymity as the need for follow up is eliminated Subjects of
observations are selected for reasons directly related to the problem being studied as the
principle of justice
7
Confidentiality is about the researcherrsquos responsibility to protect all data gathered within
the scope of the research and shared only with people involved in the research (Babbie
1992465ndash466 Brink 199640ndash41 45)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous The interview was part of the actual audit
that was done as part of monitoring and evaluation that was in progress in the Department
of Health following a negative auditor generalrsquos report about management of leave in
general The managers were put at ease as they were given the check list afterwards for
self-monitoring for future self-auditing
The data that were collected through Personnel Remuneration Administration System
(Persal) identified employees through the Persal number and kept their identity anonymous
The data that were collected through the hard copy of employeesrsquo files were used to point
out areas of concern to the managers and the files did not leave the office of the manager
at the end of the process once more protecting the identity of the employee
110 LIMITATIONS OF THE RESEARCH
The research was conducted on four hospitals of different sizes specialisation and three
metropolitans with unique challenges The period of the research was confined to a
calendar year (2008) and not a financial year The focus was on absenteeism due to sick
leave of full time employees There is no distinction that is drawn between the working-man
days that are lost between shift and non-shift workers The findings may be different if all
absenteeism of employees at the time were considered for the research
111 STRUCTURE OF THE RESEARCH
Chapter 1 It provides a general introduction to the research It includes an introduction the
background and motivation for the research that provides the context the problem
statement and the significance of the research The key concepts are defined The research
design the method of data collection the sampling method data analysis and
interpretation limitations to the research are explained in this chapter
Chapter 2 This chapter considers the theoretical foundations concepts characteristics
theories approaches and classifications of workplace absenteeism Conceptual framework
of absenteeism predictors of absenteeism and various models of absenteeism are
explained Measures to control workplace absenteeism the impact of absenteeism in the
institution and management intervention strategies are explained
Chapter 3 It describes the research design different aspects of the research methods
applied and the data collection techniques used unit of analysis units of observations
construct validity and ethical considerations
8
Chapter 4 This chapter provides the organisational structure of the Gauteng Department of
Health comparisons of hospital employees different race groups of the four hospitals
gender comparisons in different hospitals and comparisons of the different occupational
groups It provides a short description of the target hospitals The research interpretation is
discussed in terms of the different occupational groups and absenteeism different races
and absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism
The week days absenteeism pattern and contributions by the four hospitals to absenteeism
are presented in this chapter
Chapter 5 It provides a discussion of the research evaluation of workplace absenteeism
findings recommendations and limitations
112 REFERENCE TECHNIQUE
The reference technique that is applied in the research involves all sources that have been
consulted while doing the research When legislation is used as a source of information
reference to the specific act is used
113 CONCLUSION
Chapter 1 provides a discussion on the background and motivation of the research problem
statement and the objectives The significance of the research in South African public
institutions and private institutions of other countries and the possible contribution of the
study are explored The terminology that is used in the research is contextualised for the
purpose of the research The research design and methodology are presented in this
chapter The units of analysis the units of observation construct validity ethical
considerations and limitations to the research are also presented in this chapter
The next chapter discusses the theories of absenteeism
9
CHAPTER 2
MANAGING ABSENTEEISM
21 INTRODUCTION
The Gauteng Department of Health is classified as a public institution whose existence is
justified on the grounds that it renders health care services to the public The health care
system is encouraged to develop delivery systems and practices that are in line with
international standards management practices that promote efficient and compassionate
delivery of services and ensures respect for human rights and accountability to the public
(African National Congress 199443-44) This objective can only be achieved if the resources
to provide such services are available The human resources are a vital factor for the health
care sector as it is labour intensive Public institutions such as the Gauteng Department of
Health are funded from public funds and if the human resources do not report for work
service delivery is compromised and the cost to the department in the form of salary
expenditure becomes exorbitant as the department must find replacement staff and pay
for overtime as well It is when all these factors are taken into consideration that workplace
absenteeism becomes a cause for concern for the Gauteng Department of Health
In this chapter absenteeism is discussed from a theoretical perspective and informed by
literature review The classification of workplace absenteeism theoretical perspective
definitions dimensions of employment relationship conceptual framework of absenteeism
structural model of absenteeism legislative framework that regulates the employment
relationship and intervention strategies to control workplace absenteeism are explored
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM
According to Viviane (20111) the term absenteeism was first used in Britain during the
First World War in dealing with employed persons It is during the times when production is
of pressing national importance that the absence of employees from the workplace is keenly
felt Absenteeism is considered a good barometer of staff morale an indirect measure of
employeesrsquo health and well-being and is found to be associated with health-related
absences from work Employees who are motivated and committed to their work and
employer have to be very sick before they book off sick (Griep Rotenberg Chor Toivanen amp
Landsbergis 2010179)
McCormick and Ilgen (198556-57) describe job attendance criteria as relating to a tendency
of employees to withdraw from or attend to their jobs The criteria identified were job
tenure occupational category absenteeism and tardiness According to Markussen
Rogeberg and Gaure (20096) employee characteristics such as age gender education and
occupation have a substantial impact on absence behaviour
10
Chaudhury and Hammer (20033) identified that medical skills and nursing skills are
marketable and greatly in demand Doctors and nurses used this opportunity to make
money and work as private health care providers as well as public health care providers
holding two jobs The absence is considered in terms of morning or afternoon absence by
these categories as they are viewed as having a great deal of discretion over where and
when to discharge their public responsibilities The criteria identified were job tenure
absenteeism and tardiness
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) refer to absenteeism
as non-attendance when an employee is scheduled to work The theoretical perspective of
absenteeism takes into account the physical and or psychological absence of the employee
from the workplace or work station at a time when the employee is contractually expected
to be at the workplace According to Andrews (199734-35) the behaviour and actions of
public officials are determined by specific ethical codes of conduct and it is assumed that
their actions are for the benefit of the communities that are serviced by the public officials
Social ethics focus on how the clients of the Department are treated and are therefore
concerned with the impact of decisions on people inside and outside the institution
individually and collectively
Grogan (2005237) states that employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
look for trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
2001 section F(c) In the public sector contractual employee benefits are modified by
collective agreements These benefits are material gains for the employees and have a
monetary value and a cost factor to the employer
The contract of employment often includes insured benefits such as incapacity ill health
and early retirement as the total package other than the remuneration for the time worked
as it is intended to attract retain and motivate employees (Breetzke 20091 Ferguson et al
200137 LexisNexis 2006670 LexisNexis 2007176 Markussen Rogeberg amp Gaure 20093
Tustin 199452) The policy on Determination on Leave of Absence requires a medical
certificate for sick leave of three or more days and for every sick leave day utilised when the
eight week rule has been transgressed (DPSA 2009 Section 14 subsection 147)
Political ideologies influence the work environment resulting in some areas being highly
unionised where unions are perceived to be capable of exerting control over the employer
and employee relations for the primary benefit of the employees
11
It is the work environment which is highly unionised that is characterised by high workplace
absenteeism (Andrews 199736 Breetzke 20091 Du Toit amp Van Der Waldt 1998170139
Tustin 199452) Allen (1984331) claims that union members might be absent more
frequently from the workplace than non-members because they face smaller penalties for
absenteeism According to Markussen et al (20095 21) workplace environments do have an
impact on absenteeism and are influenced by social interaction processes among
colleagues Absenteeism is affected by social norms Workplaces with high employee
turnover rate tend to have high absenteeism The turnover rate is defined on a quarterly
basis as Min (number of entries number of existing persons) divided by the number of
employees at the start of the quarter The Charted Institute of Personnel and Development
(CIPD) (200811) claim that the 2006 survey of absence management portrays the public
sector employees as less likely to be dismissed for reasons of workplace absenteeism A
report by the National Institute of Labour Studies (Tonya 20011) found the rate of
absenteeism increased among full-time employees from 2 4 to 25 within two years
The services that are provided by the Department of Health are divided into two distinct
categories Direct services are those services that are rendered to the clients who are
patients who receive medical treatment from the core employees usually referred to as line
functionaries Direct services can only become effective and efficient when supported by
the services of the support staff that provide indirect health care services When employees
do not present themselves for work when scheduled to work and do so on a regular basis
the situation becomes habitual absenteeism (Du Toit amp Van Der Waldt 199818) The
Gauteng Department of Healthrsquos core function is to provide health care services to the
people of Gauteng Province The provision of health care services is labour intensive and
requires large numbers of personnel for effective service delivery
The workplace which may be physical or virtual for the public service employees represent
the internal environment of the institution The employer who is represented by the
manager determines the workplace for employees
Rogers and Hertin (1993217) explain the Decision Model Theory as a conscious decision by
the employee to stay away from work or come to work based on which motivation is
stronger at that moment It is not based on the ability to come to work
Serneels et al (2008210) claim that absenteeism is rife in the public sector especially where
employees hold two jobs The actions of public officials in the performance of their duties
should be ethically justified as it impacts on the decisions of people within and without the
institution individually and collectively Tension and job insecurity in the workplace
manifests as absenteeism (Andrews 199733-137)
12
Frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased staff
morale and high cost to health care (Davey amp Cummings 2009312-313) It is suggested that
on average health care workers are likely to be absent from work as a result of illness or
injury rather than other occupations Dagmara (20002) states that absenteeism may be a
benchmark of what is happening in the hospital setting Absenteeism is defined as habitually
not coming to work when scheduled to It is an indicator of psychological medical or social
adjustment to work
Absenteeism is measured by frequency or duration of work-days missed Frequency
measures provide a reasonable index of voluntary absenteeism whereby each incidence or
episode of absence is counted regardless of the duration of absence It is defined as the
number of days absent over a given period of time Other measures used were total days
duration and percentage Duration measures provide an index of involuntary absenteeism
such as time lost index To assess absence duration the total number of days is tallied
regardless of the number of incidents (Davey amp Cummings 2009313) High workload is
identified as one of the factors that affect absenteeism rate among health care workers
(Oi-ling 20023)
Workplace absenteeism is costly for an institution in terms of lost working-man days hiring
of staff to close the shortage absent or sub-standard service delivery and poor quality of
services The total cost of employment risk approach is about the estimation of the possible
cost of any absent employee to an institution per hour The annual cost to the institutions
per employee is in terms of direct and indirect costs such as overtime low productivity and
a decline in morale among workers who are expected to cover for an absent employee
(Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
The public service employees enjoy security of tenure which may be a contributory factor
of absence from work without good cause This practice is fostered by the knowledge that
they cannot be easily dismissed from their jobs therefore have the belief it is right to stay
away from work Misuse of sick leave is considered to be an overriding problem in instances
where the employee does not uphold the standard of honesty and incorruptibility or these
values are not considered to be the corporate values and norms of the institution (Andrews
1997 221-222 MINTRAC 20093)
Bangali (20043-5) describes age function in the sociological theory as a natural
characteristic of human beings but also an integral aspect belonging to the structure of the
society The age definition in the labour market is influenced by the structural functionalism
The employees age is categorised in the workplace in terms of functions to be performed
be it physical or intellectual The age group of 35 years to 49 years old employees comprise
the largest age group in the labour market
13
The employees who are less than 20 years of age reflect the highest absenteeism rate while
employees above 50 years of age reflect a decrease in the absenteeism rate The
disadvantage of the older workers is that their disabilities last longer once they are injured
and are more likely to be absent as frequently and more likely to be injured than younger
workers Keese (20062) states that ageism is evident in the public service and describes the
age group 25 years to 49 years old as prime age Rogers and Hertin (1993219) found a
significant correlation between the use of sick leave and age Employees with advanced age
used comparatively more sick leave in comparison with the younger employees The
Canadian Nurses Association (20065) noted a reduction in workplace absenteeism rate
among nurses who are less than 45 years of age and an increase in the absenteeism rate
among nurses above 55 years of age
Camp and Lambert (20054) found that the use of sick leave retention as an incentive to
reduce use of sick leave by the employees under the Civil Service Retirement System (CSRS)
leads to a reduction of absenteeism as a result of sick leave compared to the Federal
Employees Retirement System (FERS) who within the same company lost the unused sick
leave when they retired The Employees Retirement System (FERS) applies the same
principle of handling sick leave as the Gauteng Department of Health in the sense that
unused sick leave is forfeited at the end of the three year cycle (DPSA 2009Section 14)
Unruh and Strickland (2007674) found that absenteeism from the workplace does
contribute to a vicious cycle of a negative work environment which leads to more
absenteeism and increased turnover Absenteeism has been found to be higher in
employees who are over 50 years of age and the phenomenon is attributed to age and
changing abilities that increase when work is performed on a full time basis Part-time
arrangements reduce absenteeism as well as the cost of paying for a senior employee even
if seniority is just in tenure Age has been linked to a negative turnover in an institution The
older employee is less likely to leave the organisation An institution is healthier for a spread
of ages Some organisations consider employees to be older in batches or cohorts of five
such as 40 years to 44 years up to 64 years (Nichols amp Evangelisti 2001285 McGoldrick amp
Arrowsmith 200184 MINTRAC 20093 Reday-Mulvey 200579-194)
MINTRAC (20094-8) states that gender moderates the age turnover relationship Women
are more likely to remain in their jobs the older they get than men do Turnover is
occasionally related or preceded by high workplace absenteeism The occupational category
is linked to skill levels and salary levels The lower skill employees are concentrated in the
lower skill occupations and easily replaceable
14
Hirschfield Schmitt and Bedeian (2002553) conducted a research on low-wage public
sector clerical employees and found that those employees who perceived limited
performance-reward expectancies were likely to be absent more often The link between
skilled employees and absenteeism suggested that employees may have utilised
absenteeism as a means of compensating for perceived workplace contributions not
extrinsically rewarded
According to Gaudine and Gregory (2010599) the Canadian Institute for Health Information
(2007) found that absenteeism was a problem among health care workers in comparison to
other employees in other sectors Unruh et al (2007673) found the combination of high
registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery Markussen et al (200921) claim that the type of occupation an
employee is engaged in has an impact on absenteeism
221 Classification of absenteeism
The employees of the Gauteng province and their attendance at work are the focal point of
the province in relation to service delivery that is customer focused Health care services are
labour intensive and require employees to be at work when scheduled to do so (Gauteng
Province 201015) Workplace absenteeism can present in different forms and levels as a
result of a combination of variables (Andrews 19975 Breetzke 20091) McCormick and
Ilgen (198557) and Davey and Cummings (2009313) classify absenteeism as voluntary
when the absence is based on the conscious decision by the health care giver to withhold
contractual services The absence is uncertified unauthorised and unexcused while
involuntary absenteeism occurs for reasons beyond the control of the health care giver
such as illness injury or family responsibility Employers are challenged with the task of
differentiating between the absence due to elective workplace absence and absence due to
illness incapacity The differentiation is based on whether the illness incapacity is validated
by a legitimate medical certificate in terms of the prescript of section 23 of the Basic
Conditions of Employment Act (BCEA) 75 of 1997 (RSA 1997)
222 Definition of key concepts
Concepts are defined for common understanding in the context of the study
Workplace absenteeism Workplace absenteeism is absence of the employee at the
workplace that is defined by Du Toit and Van Der Waldt (1998139) as the place that the
institution makes available and where officials have to perform their work It forms part of
the internal environment for public administration in the public service Bamford Klein and
Engelbrecht (199911) refer to absenteeism as employees taking time off that has not been
scheduled
15
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) claim that
absenteeism is non-attendance when an employee is scheduled to work The European
Foundation (199711) views absenteeism as temporary or permanent incapacity for work as
a result of sickness or infirmity According to Robbins Odendaal amp Roodt (200415)
absenteeism is a failure of an employee to report for work as scheduled regardless of the
reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work The employee
should actually intimate expressly or by implication the intention not to return to work
According to Venter (2003267) desertion occurs when the employee leaves the place of
employment without the intention to return to work
Employee The Basic Conditions of Employment Act no 75 of 1997 Section 1 (a) (RSA 1997)
and Todd (20011) refers to an employee as any person excluding an independent
contractor who works for another person and is entitled to be paid for it or who in any
manner assists in carrying on or conduct the business of the employer The courts use the
control test which identified employees on the basis that they were part of the employer
organisation Bendix (2000123) claims that an employee is a person in a workplace except a
senior managerial employee whose status and contract of service grants the employee the
authority to represent the employer in interactions with the workplace forum to determine
policy on behalf of the employer and make decisions which might conflict with
representation of employees at the workplace Du Toit Bosch Woolfrey Godfrey Rossouw
Christie Cooper Giles and Bosch (200368) state that an employee is a person who works
for a single employer in a permanent fulltime capacity is subject to the supervision of the
employer and receives regular monthly or weekly remuneration and is obliged during
working hours to place his or her productive capacity at the employerrsquos prescribed disposal
Employer
Bendix (2000129) defines an employer as any person except an independent contractor
working for another person or the State and who receives remuneration or any manner
assists in carrying out or conducting the business of an employer DPSA (PILIR) (20094)
states that an employer is the Head of Department or a designated office which will be
responsible for the handling and investigation of incapacity leave applications and ill- health
retirement applications
16
23 EMPLOYMENT RELATIONSHIPS
The employment relationship is about balancing the simultaneous convergent and divergent
interests of the employer and the employee in a regulated manner with the aim of getting
the work of the institution done According to Erasmus et al (2005442) an employment
relationship exists when an individual is employed by someone else to be available to work
for that person in exchange for some remuneration It is through this employment
relationship that reciprocal rights and obligations are created between the employer and
the employee The employment relationship is conflictual in nature (Andrews 199736) The
employees through this relationship are enabled to gain access to the rights and benefits
associated with their employment The Labour Relations Act no 66 of 1995 (RSA 1995)
regulates the management of the conflict in the employment relationship through dispute
resolution structures such as the Commission for Conciliation Mediation and Arbitration
(CCMA) Labour Court and Labour Appeal Court when internal processes fail to resolve the
conflict The employment relationship can be traditional or typical and terms and conditions
of service of employment are regulated by collective agreements This is a tacit
acknowledgement of the existence of a typical employment relation
231 Employment relationship as a multi-dimensional phenomenon
Industrial relations and human resource management are bound together by the
employment relationship through labour employer and industrial relation triangle The
employment relationship is characterised by various dimensions as is the case in a broader
society The dimensions are economic legal individual collective and psycho-social (Grogan
200347)
2311 Economic dimensions
The economic dimension arises through the provision of labour by the employee in the form
of skill knowledge energy abilities and productive time to the employer in exchange for
remuneration Barker (200779) states that a reduction in working hours increases the
hourly cost of production in a unit unless there is a commensurate increase in productivity
The economic dimension is highly regulated The contract of employment includes insured
benefits such as incapacity ill health and early retirement The tendering of services by the
employees is a prerequisite to the employeersquos right to claim remuneration (Grogan
200347) According to LexisNexis (2007176) and the Public Service Regulations 2001
Section E E1 the actual contractual benefits are modified by collective agreements in the
public service sector Employee benefits are material gains for employees that have
monetary value and are a cost factor to the employer The Public Service Regulation 2001
Section F (a) states that the Head of Department shall promote economic and efficient use
of resource to improve the functioning of the public service (RSA 2001)
17
According to Ferguson et al (200137) and Erasmus et al (2005380) employee benefits are
the total compensation package other than the pay for time worked offered to employees
either partially or completely funded by the employer contributions In 2006 about R19
billion was lost on account of absenteeism from sick leave (LexisNexis 2006670 Patrick
2001 17)
Employee benefits are intended to attract retain and motivate employees Some of the
benefits offered to employees are mandated by law such as minimum leave provision as
contained in the Basic Conditions of Employment Act 75 of 1997 and Resolution 72000 of
the Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
2312 Legal dimension
The Labour Relations Act 66 of 1995 Section 3 of Schedule 8 requires that while employees
should be protected from arbitrary action employers are entitled to satisfactory conduct
and work performance from their employees The legal framework provides for the
regulatory requirements for human resource management in the working environment
Grogan (200347) and Grogan (2005120) view the employment relationship as formalised
by a legally binding agreement which is the contract The contract is regulated by specific
laws and formal rules with all the inherent rights and responsibilities to the employer and
the employee In terms of the employment contract one of the responsibilities of the
employee is to render service to the employer at specified agreed upon time except where
the employer has authorised the absence of the employee from the workplace Employees
have a fundamental duty to render services and the employer has a right to expect the
employees to tender such services A basic element of the duty to render service is that the
employee must be at the workplace at the specified agreed upon times unless there is
adequate reason to be absent Bendix (2000120) states that a contract is subject to the
terms and conditions of collective agreements The contract is subject to automatic changes
whenever a new collective agreement is in place The contract and its inherent benefits are
breached by elective absence behaviour of the employee The legal dimension has an
impact on the individual dimension
2313 Individual dimension
The employee enters into a working contract with the employer on an individual basis The
contents of the contract are subject to the Basic Conditions of the Employment Act 75 of
1997 The terms and conditions of employment in the public service are subject to collective
bargaining and collective agreements which influence the employment contract in the
Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
18
The contract of employment is entered into between the employer and the employee under
the supervision of the employer and for remuneration purposes
2314 Collective dimension
According to Slabbert and Swanepoel (20017) the collective dimension of the employment
relationship refers to the organised group aspect of the employment relationship which is
between labour as a group and employers and or their representative public sector
institutions The collective dimension aspect of employment relationship pertains to
legislation relating to bargaining dispute resolution and industrial action
2315 Psycho-social dimension
The psycho-social dimension of the employment relationship represents the unexpressed
needs and expectations of the employer and employees It refers to behaviour in the public
sector institutions within the context of the collective dimension (Davey amp Cumming 2009
313 Erasmus et al (2005442) The Public Service Regulation 2001 Section B states that the
Head of Department shall determine the working time of employees and take into
consideration their personal circumstances which have a social dimension (RSA 2001)
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM
Davey and Cummings (2009322) amalgamated two theories to create a theoretical
framework with the premise that employee attendance is based on two factors the ability
to attend and motivation to attend The theoretical framework focuses on individual work
ethics demographics and from the work environment Some form of absenteeism may be
difficult to prove in a situation where the employer has two or more operational stations or
the employee occasionally operates from a virtual office The duty to render service is
breached by the employee when the employee is physically present and mentally absent as
would be the case of sleeping on duty Workplace absenteeism is multi-dimensional such as
changes in the work environment that overburden the coping mechanism As a result of this
approach a multi-dimensional framework of absenteeism clouds the causative factors of
absenteeism (Breetzke 20091 Patrick 200124 Tustin 199452)
19
FIGURE 21 CONCEPTUAL FRAMEWORK MODEL
(Adapted from Davey amp Cummings 2009320)
The conceptual model uses individual predictors of absenteeism such as age salary level
tenure race gender occupation educational level job satisfaction and organisational
commitment ability to attend and pressure to attend Organisational commitment is
described as having loyalty to the organisation identifying with its core values and
influences whether or not an employee feels it is appropriate to take unauthorised
unscheduled absences Group level absenteeism is not viewed as a predictor of individual
absenteeism (Davey amp Cummings 2009320 Lambert Camp Edward amp Saylor 20058-9)
25 PREDICTORS OF ABSENTEEISM
Oi-ling (20023-6) claims that in Hong Kong there were 47500 work days lost as a result of
employee sick leave in 1998 and suggests the examining of stress levels for nurses in
different cultures to enable a fuller understanding of the predictors of absenteeism as
different cultures accept some predictors and some reject the same reasons for illness
20
Personal characteristics
2Employee value Job
expectation
1Job situation scopejob level role
stress work amp group size leadership
style
4 Satisfaction
with job situation
3 Ability to attend Illness and accidents transport problems
6 Attendance motivation
7 Employee
attendance
5 Pressure to attend work
incentiveswork ethics
Education
salary
tenure age
gender race
Occupation
Lambert et al (20058) claim that organisational commitment job satisfaction job stress
health issues and personal characteristics correlate as regards employee absenteeism The
findings of the research by Van Der Westhuizen (2006136) focused on high and low
combination of job involvement and organisational commitment and the outcome was
emphatic on the turnover as predictor of absenteeism
According to Unruh and Strickland (2007674) absenteeism from the workplace contributes
to a vicious cycle of a negative work environment which leads to more absenteeism and
increased turnover McCormick and Ilgen (198556) describe turnover as dysfunctional
where an employee wishes to leave the institution and the employer prefers to retain the
individual and is functional where the employee wishes to leave the institution and the
employer accepts the termination of services by the employee
De Wit (2006) focused on attitudes towards job factors that had an influence on
absenteeism and was not able to find a high coefficient in the test sample McGoldrick and
Arrowsmith (20018) claim that an organisation is healthier for a spread of ages Ferguson et
al (200138) state that aging employees expose organisations to high levels of absenteeism
through higher probabilities of becoming disabled for longer periods
Oi-ling (20023-6) and Patrick (200124) found that gender and age among other predictors
of absenteeism have a significant influence on absenteeism Age was positively related to
well-being in managers and negatively related to absence frequency among hospital
employees Older employees were shown to have higher responsibility at work and utilised
minimal days for sick leave Female employees were observed to have utilised more
absences than males
Andrews (1997221-222) and MINTRAC (20093-8) state that gender moderates the age
turnover relationship Women are more likely to remain in their jobs the older they get than
men do Turnover is occasionally related or preceded by high workplace absenteeism The
occupational category is linked to skill levels and salary levels The lower skill employees are
concentrated in the lower skill occupations and easily replaceable Public service employees
enjoy security of tenure which maybe a contributory cause of absence from work without
good cause a practice that is encouraged by the knowledge that they cannot be easily
dismissed from their jobs therefore have the belief it is right to stay away from work
Rogers and Hertin (1993217-222) found a correlation between the use of sick leave and
age Employees with advanced age comparatively used more sick leave in comparison with
younger employees The level of education seems to have influenced the use of sick leave
where the lower level categories of employees were found to have a higher level of
absenteeism than higher educated individuals
21
Robbins et al (200447) state that married women employees have fewer absences and
undergo fewer job turnovers Rogers and Hertin (1993222) express tenure as work
experience in years that is viewed as a predictor of employee productivity where seniority
has been found to be inversely related to absenteeism in terms of frequency and total
number of work-man days lost The level of education was found to have an influence
where the lower category of employees was found to have higher levels of absenteeism
than higher educated employees Jacobs and Roodt (2011425) and Davey and Cummings
(2009320) state that an organisational culture in hospitals can contribute towards lower
turnover as the turnover rate is a predictor of absenteeism The process can be facilitated
by promoting knowledge sharing that can provide opportunities that may meet employee
expectations
Pousette and Hanse (2002229-231) suggest that theories that make predictions about
antecedents to ill health and sickness absence make the assumption that the relationships
are the same in different occupations Reduced job autonomy is suggested to be associated
with higher sickness absence The occupation specific model is used in order to identify the
variance in the patterns in terms of occupation-groups Davey and Cummings (2009320)
found that turnover was significantly related to absenteeism
Hirschfield et al (2002553) conducted a research on low-wage public sector clerical
employees and found that those employees who perceived limited performance-reward
expectancies were likely to be absent more often The link between skilled employees and
absenteeism suggested that employees may have utilised absenteeism as a means of
compensating for perceived workplace contributions not extrinsically rewarded Unruh et al
(2007674) found that absenteeism from the workplace does contribute to a vicious cycle of
a negative work environment which leads to more absenteeism and increased turnover
26 A MULTI-GROUP INVARIANCE MODEL
A multi-group invariance structural model represents different types of occupations such as
industrial blue-collar workers industrial collar workers elderly care workers and child
health care workers The focus of this model relates to the extent to which a model that is
assumed to include a general population also includes sub-populations such as different
occupational types The occupation specific model allows different relationships between
variables in different occupations The specific model approach allows for identification of
the most common reasons for absenteeism and early retirement in the workplace and was
successfully utilised in Sweden A common model proposes that absenteeism is a
behavioural response to dissatisfaction with the job (Pousette amp Hanse 2002230-244)
Nyathi (200059) found that professional nurses were absent from work because they
wanted to prolong their weekends
22
Davey and Cummings (2009313) argue that on average health care employees are more
likely to be absent from work as a result of illness or injury than other occupations Paton
(20104) acknowledges that line managers are the fundamental building blocks for reducing
absenteeism and must be provided with the tools to manage absence The absence rate at
3 is considered very high and must be vigorously and progressively managed
FIGURE 22 MODEL SPECIFICATION
(Adapted from Pousette amp Hanse 2002232)
Pousette and Hanse (2002232-245) make the assumption that low job autonomy and low
skill discretion deprive the employees of the opportunity to handle work obstacles and
regulate workload to a manageable level implying a negative relationship to workload has
an impact on absenteeism rate Patrick (200123-24) states that changes in the working
conditions overburden the coping mechanism Work-related stress can lead to deteriorating
physical and emotional well-being The work object is the distinguishing quality between
occupations in the different occupational groups whereby the blue-collar employee works
with things that are tangible such as materials and machines whereas the white-collar
employee is knowledge based employee who is working with data
23
Structural Model
W L Work load
I H Ill-Health
S A Sickness absenteeism
S D Skills discretion
(autonomy)
27 CATASTROPHIC MODEL (CAT)
According to Buschak Craven and Ledman (199628) the catastrophic model (CAT) caters for
major illness that keeps the employee away from work for extended periods of time This
model is similar to short and long term incapacity sick leave whereby the employee has
exhausted the normal sick leave of 36 days which is catered for by DPSA section 14 (RSA
2009)
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM
The general behaviour and actions of public officials are determined by specific ethical
codes of conduct and the unethical conduct results in effective administration and
unsatisfactory service delivery (Andrews 199733) Effective control of workplace
absenteeism requires an absenteeism policy to be in place management to establish the
magnitude and patterns of absenteeism and raise awareness about the consequences of
breaking these rules (Bamford Klein amp Engelbrecht 19992)
The Determination on Leave of Absence in the Public Service (DPSA 2009 section 14 141)
the Public Service Co-ordinating Bargaining Council Resolution (PSCBC 72000) Davey and
Cummings (2009313) and DPSA (PILIR) 2009 section 3 31 state that an employee is
entitled to 36 working days sick leave with full pay in a three year cycle with the same
employer Any unused leave credits shall lapse at the end of the three year cycle The
employee is expected to utilise and manage the normal leave circumspectly The employee
who chooses to utilise sick leave days must submit a medical certificate for every occasion
of three or more sick leave days utilised The medical certificate must be issued and signed
by a practitioner or persons who are registered with the Professional Councils established
by the Act of Parliament Incapacity leave is additional sick leave granted conditionally at the
employerrsquos discretion An employee who has exhausted the normal sick leave during the
prescribed sick leave cycle and who requires to be absent from work due to a temporary
incapacity may apply for temporary incapacity leave with full pay According to the Policy
and Procedures on Incapacity Leave for Ill-Health Retirement (PILIR) (DPSA 2009) an
employer is not required to pay an employee if the employee has been absent from work
for more than two consecutive days or more than two occasions during an eight week
period and on request does not produce a medical certificate
The Public Service Regulations 2001 F (c) holds the manager accountable when an
employee abuses sick leave (RSA 2001) According to Parbhoo (20036) and Nel et al
(2008145) the doctor patient confidentiality is not above reach to the employment
relationship by suggesting that the employer can question the authenticity or contents of
the medical certificate if there is sufficient reason to do so within the confines of
confidentiality
24
According to Breetzke (20092) South African employees are challenged by global trends to
seek mechanisms to deal with excessive absenteeism at the workplace The Charted
Institute of Personnel and Development (CIPD) (200811) claims that the 2006 survey
showed that public sector employees are less likely to be disciplined or dismissed for
reasons of workplace absenteeism
281 Measuring absenteeism
Measuring absenteeism in the workplace enables the employer to determine the extent and
nature of the problem Absenteeism is measured using two measures total time lost and
absence frequency Nel et al (2001584) In institutions total time lost is determined for
every group of employees and category of absence such as sick absence authorised and
unauthorised absence The recognised international norm is 3 Institutions challenged
whether to accept the international norm as the given or strive to bring workplace
absenteeism down in the interest of quality and quantity of service delivery The total time
lost index is calculated as the Total number of days lost due to absence over the period
multiplied by a thousand and divided by the average number of employees multiplied by a
thousand and divided by an average number of employees multiplied by total work-days
over the period (Amin Das amp Goldstein 20086 Breetzke 20094 Nel et al (2001584)
According to Nel et al (2001584) high workplace absenteeism rate is suggestive of incidence
that is of short duration and therefore more disruptive to the operational plans of an
institution as prior knowledge of pending workplace absenteeism allows for forward
planning and reduction of the costs associated with absenteeism The absence frequency
rate is calculated as Number of absence incidence over the period divided by the average
number of employees employed over the period (Breetzke 20094 Nel et al 2001254)
29 IMPACT OF WORKPLACE ABSENTEEISM
Lambert et al (20056 36) claim that absenteeism has adverse effects on those employees
who are good attenders as they are shuffled around to fill in the positions of absent
employees Organisations suffer the detrimental effects and consequences of employee
absenteeism Management expend valuable time to modify employee assignments to
respond to absences When employees who are in management or in highly specialised job
assignments report sick the work assigned to them remains undone because their positions
remain vacated and the work remains for them to complete The responsibility and
accountability these employees are entrusted with may influence less use of sick leave by
them
The White Paper on Transforming Public Service Delivery (DPSA 1997) holds management
responsible for the specific level of resources and for obtaining value for money in these
resources
25
Madibana (201022) found in the research about absenteeism amongst nurses that the high
rate of absence had an impact in the reduction of quality care rendered by nurses
291 Cost to the institution
Andrews (19978221) describes an institution as the process through which activities are
grouped logically into the distinct areas and assigned to managers It results in the logical
grouping of activities in a department Workplace absenteeism influences the cost of an
institution which influences the quality of the product or service that is rendered by the
institution Employee attendance is a vital element for managing productivity of any
institution and its individual members The unfilled posts reflect the absence of public
health care employees and do not absorb budget resources for salary and upkeep of
facilities Absent personnel still receive their salaries If public servants are not on the job
the expenditures embodied in them do not reach their beneficiaries (Chaudhury amp Hammer
20032 Lambert et al 20055) The cost is direct in terms of salary expenditure or indirect in
terms of staff replacement
Ferguson et al (200138) argue that the cost of employment risk approach is about
estimation of the possible cost of any absent employee to an institution per hour per day
Robbins Odendaal and Roodt (200415) estimate that absenteeism costs South African
institutions millions of rand a year in decreased efficiency and increased benefit payments
Fakie (20053) notes that sick leave costs the national government 15 of the total basic
salary expenditure for the National Department of Health from 1 January 2001 to December
31 2003
The South African Chamber of Business (SACOB) (Patrick 200117) acknowledges that in
2006 about R19 billion were lost on account of absenteeism resulting from sick leave
According to the European Foundation (19977) United Kingdom lost 11 billion pounds in
1994 Germany lost 30 5 billion EUC in 1993 and Belgium lost 24 billion EUC in 1995
Breetzke (20092) describes indirect costs as hidden costs harder to measure and may
include economic value of lost productivity Indirect costs relate to loss of production that
may arise by engaging some expects to provide service in the field where they are closing
the staff shortage gap Rogers and Hertin (19939) and the European Foundation (19978)
view the individual employee and his or her dependants in a social dimension aspect as
exposed to reduced income as a result of extended workplace absenteeism related to ill
health where long term incapacity is involved
The total cost of employment risk approach is about estimation of the possible cost of any
absent employee to an institution per hour The cost may be direct and indirect such as
overtime low productivity and a decline in morale among workers who are expected to
cover for an absent employee (Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
26
292 Low productivity
According to Jankowitz (19911) high levels of absenteeism are disruptive to production
where operators are interdependent or where levels of service have to be maintained
Buschak Craven and Ledman (199626) argue that absenteeism generates costs for the
institution and productivity problems put an unreasonable burden on the rest of the
employees who are at work An absent employee be it physical or psychological remains an
unproductive employee Absenteeism viewed from an employerrsquos perspective is regarded as
a problem that impacts negatively on service delivery while the employeesrsquo believe their
mere presence in the workplace is being productive
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM
Managing workplace absenteeism remains a challenge for all employers and the Gauteng
Department of Health has not been spared the challenges faced by other institutions as it
provides health care services to the citizens of Gauteng The provision of good quality health
care is vital for the development of human capital The implications of declining quantity
and quality of care is grave when the human capital equity and efficiency which are the
cornerstones of health care service delivery are threatened by employees who are not at
work when expected to be (Gauteng Province 200711) Misuse of sick leave is considered to
be an overriding problem in instances where the employee does not uphold the standard of
honesty and incorruptibility or these values are not considered to be the corporate values of
the institution (Andrews 1997 221-222 MINTRAC 20093)
According to Grogan (2005237) employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
identify trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
Part V Section F(c) (RSA 2001) The workplace can be a virtual office Workplace
absenteeism is perceived to be high in unionised workplace environments where unions are
perceived to be capable of exerting control over the employer and employee relations for
the primary benefit of the employees In the public sector contractual employee benefits
are modified by collective agreements
Public service managers are to focus towards results achievement and be accountable for
the performance of their institutions (Gauteng Province 201023) Workplace absenteeism
can be reduced by tightening up policies and procedures relating to control of absenteeism
and intensifying monitoring processes on absent employees
27
According to Cloete (2004290-297) public institutions are to provide quality goods and
services The public institutions require an appropriate infrastructure to enable them to
perform their core functions (Bamford et al 19991 Buschak et al 1996 28 Munro
200722)
2101 Effective communication
According to Oi-ling (200212) managers should alter the psycho-social environment at work
and cultivate an institutional climate that supports staff and facilitate effective
communication Institutions should raise awareness to employees of their rights and
responsibilities regarding leave of absence and the consequences of abusing it (Bamford et
al 19992) The policies should be clearly written and well communicated to all employees
and be readily available and accessible In a highly unionised environment these policies are
debated in bilateral or multi-lateral forums between management or employer
representatives and labour representatives The human resource practitioners must conduct
periodic in-house training on these policies for management and employees to facilitate
uniform interpretation and enforce compliance by all stakeholders The policies must be
couched in simple understandable language that is free of legal terms for ease of
comprehension by all users The policies on workplace absenteeism must be explicit of
actions to be taken when policies have been violated or employees are aggrieved
2102 Empowerment of managers
Workplace absenteeism is multi-dimensional requiring inputs from all related fields
Managers require on-going support and training on issues that relate to absenteeism at the
workplace The human resource unit works with managers to establish performance
standards training of employees on the importance of execution and assists managers to
focus on continuous improvements superior execution and employee empowerment
(Bergdahl 20019 RSA 2011)
The labour relations unit supports the training of managers on grievance handling bilateral
and multi-lateral encounters with employee representatives with employee education
issues specific to workplace absenteeism The Charted Institute of Personnel and
Development (CIPD) (200835) reported that 70 of managers in the public service have
been trained in workplace absenteeism handling
Employment relationships bind human resource and industrial relations together with the
common objective of achieving institutional goals and labour peace Managers focus on
managing the institution for productivity at the lowest possible cost by providing quality
care therefore reducing the risk of litigation control of absence from work and work
efficiency
28
It is the delays in dealing with issues that give the employees the feeling of being unfairly
treated and demoralised Consistency in upholding these processes is essential for creation
of a stable employment relationship while any deviation from the set processes give rise to
worker unfriendly environment (Bergdahl 20118-9)
2103 Monitoring of workplace absenteeism
The manager is expected to keep accurate records for all leave of absence taken by
employees In terms of the management of ill-health absencersquos the manager has to ensure
that the eight week rule is observed whereby the employee who has been absent from
work on more than two occasions during an eight- week period must regardless of the
duration of the sickness or injury submit a medical certificate (RSA Part V section F (b)
DPSA 2009 section 14 148) Pierce (200921) believes that management of human capital
may be achieved through the integration of employee benefits employee assistance
programmes and human capital
Monitoring of absenteeism is a human resource function that gets lost in the competing
functions that are carried out by human resource practitioners High levels of absenteeism
are an indication of poor management and or conflict within the employment relationship
The methods to monitor workplace absenteeism vary from one institution to the other It is
human resource management that establishes common guidelines that are used by
management to monitor workplace absenteeism In monitoring absenteeism the manager
considers each employeersquos case on its merit
The manager focuses on certain aspects of the case such as failure to call in on the day of
absence pattern of use of sick leave before or after holidays and sick absence occurring on
certain days of the week or month Monitoring systems to monitor and record attendance
of work are put in place to assist management with simple accurate functional data that
facilitates informed decision- taking at management level The employees of the province
and their attendance at work become the focal point of the province in relation to service
delivery Peer pressure monitoring comes from colleagues at the same facility Hierarchical
monitoring of employees by management may lead to more attendance for fear of being
discovered (Chaudhury amp Hammer 200319 Gauteng Province 201015) A health care
service institution may use Health Information System and Personnel and Salary
Administration System (PERSAL) among others to ease the burden of the monitoring
process All these tools combined are useful in gathering administrative data for
management
29
2104 Visits to facilities
The role of human resource at institutional level is to support and guide management as
well as monitor compliance issues Workplace absenteeism remains a key focus area
because of its impact on the budget of an organisation Unscheduled facility visits are
conducted with the view to audit workplace absenteeism The audit is to be done in line
with the auditor-general or internal risk managementrsquos approach to encourage consistency
A check list that is used is prepared by human resource practitioners and institutions are
familiar with A human resource accounting officer of the institution should be involved
when an audit is done
The institution must have evidence available of sporadic visits to employees who have been
identified as having developed absenteeism patterns with the view to rule out elective
absence The European Foundation (199713) and Munro (200722) state that ill- health is
the main reason for workplace absenteeism Employees who present with ill- health are
generally and frequently more absent from work than the healthy ones The authors also
observe that not all employee assistance programmes aimed at reducing workplace
absenteeism have an effect on the ill-health of the employees which render the
unscheduled visit to the employees vital to see where the caring employer could be of
assistance
2105 Incentive system
According to Buschak et al (199628) the catastrophic model (CAT) caters for major illness
that keeps the employee away from work for extended periods of time This model is similar
to short and long term incapacity sick leave which is catered for by PILIR subsection 73
(DPSA 2009) The managers require special training for successful implementation of the
policy The paid time off model (PTO) has hidden benefits incentives for employees not to
use unnecessary sick days which are then paid for at retirement The research by Lambert
and Camp (20054) compares the Civil Service Retirement System (CSRS) and the Federal
Employees Retirement System (FERS) and showed that in the final analysis and when
novelty wore off workplace absenteeism was not necessarily reduced by the incentive
system
Management should use the strategy to raise awareness about responsible utilisation of sick
leave through workshops about PILIR and the eight week rule It should show the benefits
of good sick leave management when employees are challenged with temporary or
permanent incapacity leave
The use it or lose it approach of the current system reward the abuse of sick leave as it is
viewed as not being beneficial by the employees to act responsible towards the use of sick
leave There is no deterrent not to abuse sick leave in the public sector
30
2106 Team support
Institutions value team effort over individual achievement Operational competencies are
viewed as essential Managers encourage effective communication among team members
motivating others and the development of problem-solving skills Managers through the
team development effort encourage nurturing and transmitting of the institutional culture
Institutional culture refers to a system of shared meaning within an organisation that
determines how employees behave in the workplace Culture and people are like glue that
ensures that institutional standards are upheld Individuals become units that form the
team and conversations at work are encouraged to strengthen team work knowledge
transfer and productivity (Bergdahl 20018-10 Goldsmith amp Morgan 200378 Robbins amp
Decenzo 2001174)
2107 Return-to-work interviews
According to Paton (20101ndash5) a phased return-to-work data management and remote
services are among the approaches employers may use to manage workplace absenteeism
The intervention can involve use of Information Technology systems and telephone
discussions Good absence management is about good people management The return-to-
work interviews provide management with the opportunity to get to know the employee
better and for the employee to substantiate his or her case The employee is afforded
privacy during the sessions which should happen as soon as the employee comes back to
work The key success in this strategy is unthreatening follow ups that are done A multi-
faceted approach is used to get people back to work such as phoning maintaining regular
contact and taking medical advice
The Charted Institute of Personnel Development Annual Report (200835) reported 90 of
public services that use the strategy and 77 use the risk assessment to aid return- to-
work The manager should have private counselling sessions with the employee as soon as
the employee returns to work These sessions provide the employee with the opportunity to
put his or her case across and for the employer to get a first-hand opportunity to asses if the
employee is fit enough to come back to work The employer has to make the employee
aware of the status of the meeting that it is formal and proceedings are recorded The
employer is to keep accurate records of all counselling sessions
31
2108 Employee assistance programme (EAP)
DPSA (PILIR2009) prescribes that the PILIR committee promotes EAP in the workplace and
each institution to establish a committee The PILIR committee consists of a labour relations
officer an EAP practitioner a health practitioner an employee wellness practitioner and
any other relevant practitioner who is co-opted on a needs basis The purpose of the
committee is to manage short and long term incapacity which is sick leave utilised after the
employee has exhausted the 36 days normal sick leave in a three year cycle The short term
incapacity sick leave is of longer than three days and less than 29 days and long term
incapacity is sick leave longer than 29 days The short spells of sick leave become a concern
when there is evidence of a pattern of abuse It is a call for the manager to intervene Every
organisation should provide EAP that is funded by the employer to the employees A health
risk manager is used by the employees who are expected to honour referrals and stay with
the programme until such time that there is evidence of recovery failure by the employee
to accept the programme should attract a disciplinary process
According to Mellor Arnold and Gelade (20098) the amount of support that followers
receive from their transformational leader or co-worker may help reduce levels of absence
by making the workplace a more pleasant place to be and perhaps by helping the person
find solutions to work out family conflict or other problems that produce absence Landstad
et al (20011) suggest that the individuals in the preventive intervention group who were
less than 42 years of age total absence due to sickness decreased The change was obvious
to the cleaners who had a previous history of high absence due to sickness The Charted
Institute of Personnel Development (200836) focused on working-man days lost
management of absenteeism employee well-being and employee rehabilitation The skilled
employees were reported as 12 who were using rehabilitation programmes Yende
(200535) and Fakie (200517) state that EAP despite having been around since 1996 for the
National Department of Health has not actually been managed and utilised to its full extent
whereby if fully utilised would assist in the management of employee workplace
absenteeism
2109 Occupational and safety committee
The focus of this committee is on the provision of a safe working environment by the
employer (RSA Part VI section D 2001) It monitors issues of compliance and adopts the
employee advocacy role The committee consists of all the major stakeholders such as
employee representatives labour representatives that represent employees in the
institution on issues of safety at the workplace In the context of the Gauteng Department
of Health the committee engages with the labour representatives and employer
representatives at bilateral and provincial multi-lateral scheduled meetings
32
According to Du Toit and Van Der Waldt (1998139) the International Labour Organisation
recommends creation and maintaining of a pleasant work environment in order to improve
productivity The environment must stimulate the employee to ensure efficiency and
effectiveness
21010 Review committee
This structure is essential when dealing with incapacity leave It is composed of
management human resource practitioner employee representative labour relations
officer employee wellness and any adhoc person needed in terms of the case under
discussion (DPSA PILIR 2009) The employee reserves the right to lodge a grievance about
the outcome of his incapacity request if it is negative The role of the committee is to
provide a transparent forum reduce hostility against management and to protect the rights
of the employee through involvement of the employee representative
211 CONCLUSION
The literature review that has been consulted explores the workplace absenteeism and its
impact on the institution The employment relationships represent a triangle that consists of
the employer the employee and the industrial environment The relationship is multi-
dimensional and highly regulated with built in mechanisms to handle conflict in the
workplace Conflict is inherent to the employment relationship and structures and
mechanisms such as bargaining councils the Commission for Conciliation Mediation and
Arbitration and Labour Courts are structures for recourse The theory of absenteeism and
employment relationship were explored Management intervention strategies were
explained Controlling absenteeism in the workplace begins with a sound absenteeism
policy that is incorporated into an employee induction programme Communicating and
educating the employees about the absenteeism policy takes the centre stage in the
employment relationship Vigilant monitoring of workplace absenteeism is the responsibility
of the manager closest to the employee such as the supervisor Workplace attendance
problems of employees can be handled using sound judgement keeping accurate
attendance records and administering the policy fairly and consistently
Chapter 3 will collect data which will confirm or negate the literature review that has been
explored in chapter 2
33
CHAPTER 3
METHODOLOGY OF THE RESEARCH
31 INTRODUCTION
Chapter 3 focuses on the methodology used to determine the absenteeism in the four
hospitals of the Gauteng Department of Health The research design and the methodology
that have been used to collect data are discussed below The data are collected in terms of
the characteristics of the stratified random sample such as absenteeism of the different
occupational categories gender age tenure of service race groups and salary
32 RESEARCH DESIGN
A research design is the overall plan for relating the conceptual problem to relevant
empirical research It is a quantitative descriptive research that involves the systematic
collection of numerical information under conditions of considerable control The choice of
the research design influences subsequent research activities such as identifying the target
subjects what data to collect and how they should be collected The research design is a
descriptive survey which is concerned with characteristics of a specific population subject at
a fixed point in time for comparative purposes The focus is on a representative sample of
the relevant population It is concerned with the accuracy of the findings and their
generalisability The survey is used to understand the behaviour of employees with regards
to motivation satisfaction and grievances (Babbie 1992 89 Ghauri et al 199527 60 Brink
199611 Welman et al 200152)
321 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services The four hospitals that have been targeted for the study of absenteeism are Tara
Moross Centre Hospital in Region A under the Johannesburg Metropolitan Municipality
Germiston Regional Hospital which is in Region B under Ekurhuleni Metropolitan
Municipality ODI District Hospital in Region C under Tshwane Metropolitan Municipality
and George Mukhari Academic Hospital in Region C under Tshwane Metropolitan
Municipality Each hospital is unique in its character in terms of specialisation of health care
delivery service The sample is a stratified random sampling which is composed of various
clearly recognisable non-overlapping sub-populations (strata) that differ from one another
in terms of variables that are a combination of more than one variable such as age sex
income level or educational level The purpose is to ensure that every part of the population
(every stratum) is represented The members of a particular stratum are homogeneous with
the population at large
34
The sample is representative of a population with clearly distinguishable strata with a
greater degree of certainty (Babbie 19927 Brink 1996138 Brynard amp Hanekom 2005 44
Ghauri et al 199578 Welman amp Kruger 200155-56 Polit amp Hungler 199518)
The data were collected in three phases The first phase of data collection was done through
auditing of hard copies of identified personnel files encomprising ten files per hospital and
using the tools in annexure A and B The forty employeesrsquo profiles were accessed through
the Human Resource Information System (HRIM) located in the Gauteng Department of
Health Head Office The respective employeesrsquo profiles were handed over to the human
resource manager in the respective hospital on the morning of the audit for the human
resource practitioner to draw out the hard copy files for auditing The characteristics of the
individuals that were identified for the first phase were males and females as well as
representatives from the different race groups The auditing of the files were for the
complete working life of the employees and not only confined to 2008 calendar year
Registers that are used by human resource administration to control the movement of the
leave form were inspected as evidence of the control system in place The purpose of
auditing the files was to gain insight into how leave in general was captured managed and
controlled by the hospitals
The second phase of data collection were done through structured interviews with four
human resource managers who were directly accountable for management and control of
leave of absence in general in the four hospitals A structured interview provides for a more
organised approach and a more stable basis for assessment of the different candidates
(Erasmus et al 2005250) The structured interview was conducted using the tool in
annexure C Tara Moross Centre Hospital had been functioning without a human resource
manager and the manager that was interviewed had been in the post for three months The
human resource practitioner who was at salary level 8 and acting in the Assistant Directorrsquos
post (manager level 9) was invited to join the manager and be part of the structured
interview ODI District Hospital had three human resource practitioners including the
accounting officer at level 8 in an acting capacity The third phase of data collection was
through the Human Resource Information Management System (HRIM) This system uses
the Personnel Remuneration Administration System (PERSAL) to collect data Data in this
system is categorised in characteristics such as salary level date of appointment
occupational category gender age in units of five race employing hospital employment
status in different sub-categories such as session contract and full-time and the different
types of leave of absence The continuous sick leave of four to five days was excluded from
processing and focus was laid on sporadic days to the start and end of a weekend
35
The research used secondary data in analysing sick leave utilised by full time employees in
the identified hospitals for the period of 1 January to 31 December of 2008 using Persal The
total population sample was four thousand and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range from level 1 to
12 The research used past events such as sick leave utilised by employees using secondary
data from Persal falling into the category of historical empirical study The interval scale of
measurement was used in the quantitative research and actual numbers are ordered with
equal measurement between each category (Brink 1996 149 Brynard amp Hanekom 200528-
29 Mouton 200552100170)
33 UNIT OF ANALYSIS
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the study refers to observation of work attendance by the
employees of Gauteng Department of Health in the four hospitals The observation deals
with the historical events as employees have already utilised the sick leave in the workplace
The subjects that are studied are the core health care providers such as doctors nurses and
support employees such as allied administration and administration support (Mouton 2005
51-52 Welman et al 2001 52-53)
34 UNIT OF OBSERVATIONS
The observations that are made are of health care employees and support teams in Tara
Moross Centre Hospital Germiston Hospital ODI Hospital and George Mukhari Hospital
and describe the characteristics of a large number of individual people such as sex age
salary range occupational category tenure of service and race in relation to absenteeism in
the workplace The descriptive study and the individual characteristics are aggregated for
the purpose of describing a larger group (Babbie 199292)
35 CONSTRUCT VALIDITY
Construct validity is concerned with the question What construct is the instrument actually
measuring (Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with four of the accounting officers in the leave managements The third phase was
collecting of personnel data through the Persal system
36
36 ETHICAL CONSIDERATIONS
Ethical considerations will include amongst other issues such as the protection of the units
of analysis and units of observations from discomfort and harm by not revealing
information which can cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity
Anonymity is achieved when the researcher cannot link a given response with a given
respondent and reporting aggregate data only When data are collected at one sitting and
not over a period of time makes it possible to achieve anonymity as the need for follow up is
eliminated Subjects of observations are selected for reasons directly related to the problem
being studied as the principle of justice Confidentiality is about the researcherrsquos
responsibility to protect all data gathered within the scope of the study and shared only
with people involved in the research (Babbie 1992465ndash466 Brink 199640ndash41 45 Polit amp
Hungler 1995 31-36)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous to the researcher The interview was part
of the actual audit that was done as part of monitoring and evaluation that was in progress
in the Department of Health following a negative auditor generalrsquos report about
management of leave in general The managers were put at ease as they were given the
checklist afterwards for self-monitoring and for future self-auditing
The data that were collected through Persal identified employees through the Persal
number and kept their identities anonymous The data that were collected through the hard
copy of employeesrsquo files were used to point out areas of concern to the managers and the
files did not leave the office of the manager at the end of the process once more protecting
the identity of the employee
37 CONCLUSION
This chapter dealt with the research design which is the overall plan for relating the
conceptual problem to relevant empirical research The methodology used a stratified
random sample which is composed of various clearly recognisable non-overlapping sub-
populations that differ from one another in terms of variables that are a combination of
more than one variable The data collection was done through three phases The unit of
analysis refers to the persons who are studied The unit of observations are health care
workers and support teams in the four identified hospitals The construct validity used a
multi-trait multi-method approach Ethical considerations include among other issues
protection of the unit of analysis and the unit of observations from discomfort and harm
Chapter 4 discusses the analysis and interpretation of the data gathered in chapter 3
37
CHAPTER 4
INTERPRETATION AND ANALYSIS OF DATA
41 INTRODUCTION
This chapter focuses on the research analysis and interpretation of data gathered on
workplace absenteeism in the Department of Health of the Gauteng Province It seeks to
identify differences or similarities in the leave trends in the 2008 calendar year between the
four identified hospitals chosen for the study in the Municipality of Tshwane Ekurhuleni and
Johannesburg The year 2008 was chosen as a second year in the leave cycle that started in
2007 The type of leave of absence is interpreted as a collective that does not specify the
type of sickness or illness or it being acute or chronic Workplace absenteeism is absence of
the employee at the workplace that is defined by Du Toit and Van Der Waldt (1998139) as
the place that the institution makes available and where officials have to perform their
work It forms part of the internal environment for public administration in the public
service Direct public administration is directly concerned with the rendering of services to
the citizens of the country
Chapter 4 discusses the study of workplace absenteeism in the four identified institutions
namely Tara Moross Centre Hospital Germiston Hospital ODI District Hospital and George
Mukhari Hospital In this research the following factors will be examined the organisational
structure and absenteeism of the different workforce categories such as medical and
nursing professionals administrative staff allied professionals and various categories of the
general assistants workforce and their relation to absenteeism in the institution
42 THE STRUCTURE OF THE ORGANISATION
The Gauteng Province is one of the nine provinces of South Africa In 2005 the auditor-
general conducted an audit of sick leave performance in six national departments and the
Gauteng Province was among those that were omitted from the audit The research focuses
on the Gauteng Department of Health (GDoH) whose core function is to provide health care
services to the people of Gauteng The provision of health care services is labour intensive
and requires large numbers of personnel for effective service delivery The GDoH is serviced
by thirty-four hospitals four of which have been identified for the study of management of
sick leave The employee attendance to work is essential to the achievements of the
Departmental goals The Determination on Leave of Absence determines the leave policy for
public service employees (DPSA 2009) The employees of GDoH represent the staff
component as reflected in the organisational structure of the department
38
The Gauteng Department of Health (GDoH) provides the basic health services to the people
of Gauteng who as internal or out-patients are clients or consumers of the services referred
to as line functions Public administration services rely heavily on support services such as
the personnel department that renders support to line functions that provide the actual
service of patient care Support services are considered as indirect public administration
services and essential in efficient public service delivery Workplace absenteeism has a
negative impact on productivity Employees of the Gauteng Department of Health and their
attendance to work are the focal point of the Province in terms of effective health care
service delivery that is customer focused
Political ideologies as those espoused by labour representatives are part of the external
factors in the workplace environment that consequently have an impact on public
administration and management and workplace attendance by employees (Du Toit amp Van
Der Waldt 1998139170)
FIGURE 41 INTERGRATED ORGANISATIONAL STRUCTURE
(Adapted from Gauteng Department of Health organisational structure 2010)
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY
The Gauteng Provincial Government has made a commitment to its people to account for
the delivery of services as its electoral mandate This commitment will be achieved only
when monitoring and evaluation of its performance is enforced by all Gauteng Department
of Health service providers
39
MEC
HOD
COP
Senior Exec
CD HAST CD Health program
Senior Exc
CD Tshwane
CD JHBWest
CFO
Manage Account
SENIOR CORPORATE
HRM amp LR
GenderampDisability
The Gauteng Governmentrsquos commitment to provision of health care services to all its
citizens is demonstrated by the decentralisation of management of service delivery with the
view to foster accountability increase efficiency and accountability (ANC 199419ndash20
Goldstein 200815) The interpretation of the analysed data takes the sector performance
approach into consideration when the interpretation of absence is across all the
occupational groups for the 2008 calendar year (Gauteng Province 201015)
44 COMPARISON OF HOSPITALSPERMANENT EMPLOYEES
Gauteng employees are counted at 51475 from the Personnel Salary Administration System
(PERSAL) as of March 2008 The population from the four chosen hospitals has been
counted at 4010 reflecting 8 of the total population The different groups of employees
were identified as Africans represented as n=3902 Whites as n=51 Indians as n=14 and
Coloureds as n=43
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALS
(Source Compiled by the researcher C S Ndhlovu 2012)
Figure 42 reflects the racial split percentage of the workforce (n=4010) of the hospitals
The population from the four hospitals has been counted as 4010 reflecting 8 (n=51475)
of the total working population for Gauteng Department of Health as from 1 January to 31
December 2008 The different groups of employees were identified as Africans represented
by 973 (n=3902) Whites as 13 (n=51) Indians as 03 (n=14) and Coloureds as 11
(n=43) The George Mukhari Hospital has a female dominated workforce at 739 (n= 2097)
in a total workforce of n=2836
40
Population n=4010
Africans 973
Whites 13
Coloureds 11
Indians 03
TABLE 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALS
RACE TARA HOSPITAL GERMISTON GEORGE
MUKHARI
ODI TOTAL
Africans 227 367 2836 472 3902
Whites 23 24 3 1 51
Coloureds 5 37 0 1 43
Indians 13 1 0 0 14
Population 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 1 focuses on the distribution of race and the population of the total workforce The
geographical area of the hospital determines the demographics and the tendency of some
groups being poorly represented or totally absent The research focused on permanent
employees of the four hospitals The George Mukhari Hospital employees are reflected as
7079 (n=2839) ODI Hospital as 1182 (n=474) Germiston Hospital as 1069 (n=429)
and Tara Moross Centre Hospital as 668 (n=268) of the total working population Tara
Moross Centre and Germiston Hospitals are located in cosmopolitan areas while the George
Mukhari and the ODI Hospitals are in rural and semirural areas The positioning of the latter
hospitals may account for the high African workforce
41
TABLE 2 COMPARISONS OF NUMBERS OF ADMINISTRATION AND SUPPORT STAFF IN THE
DIFFERENT HOSPITALS
OCCUPATIONAL
GROUP
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Administration
staff
48 60 297 61 466
Administration
support
103 140 719 133 1095
TOTAL 151 200 1016 194 1561
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 2 presents the administration employees and the administration support in the four
hospitals Tara Moross Centre Hospital is represented by 3179 (n=151) of administration
and 6822 (n=103) administration support The George Mukhari Hospital has the highest
representation by the administration support at 7077 (n=1016) The high representation
of the administration support staff at George Mukhari Hospital could be partly because of
the semi-rural environment A semi-rural environment is usually characterised by poverty
which may have a negative influence on opportunities to access education and skills
Doctors and nurses are highly marketable because of the educational levels and skills that
are lucrative and enable this group to be highly mobile geographically (Chaudhury amp
Hammer 20033)
42
TABLE 3 GENDER COMPARISON IN DIFFERENT HOSPITALS
GROUPS HOSPITALS MALE FEMALE POPULATION
Africans Tara 83 144 227
Germiston 52 315 367
George Mukhari 739 2097 2836
ODI 109 363 472
TOTAL 983 2919 3902
Whites Tara 5 18 23
Germiston 5 19 24
George Mukhari 3 0 3
ODI 1 0 1
TOTAL 14 37 51
Indians Tara 1 12 13
Germiston 0 1 1
George Mukhari 0 0 0
ODI 0 0 0
TOTAL 1 13 14
Coloureds Tara 1 4 5
Germiston 6 31 37
George Mukhari 0 0 0
ODI 1 0 1
TOTAL
GRAND TOTAL
8
1006
35
3004
43
4010
(Source Compiled by C S Ndhlovu 2012)
Table 3 focuses on gender distribution in the population of the research represented by
males and females in the different racial groups
43
The geographical area of the hospital determines the demographics and the tendency of
some groups being poorly represented or totally absent The males of the different hospitals
account for 251 (n=1006) while the females account for 749 (n=3004)
The George Mukhari Hospital has a female dominated workforce at 7394 (n=2097) out of
a total workforce of n=2836 White male employees are represented by 011 (n=3) against
the total workforce of the hospital (n=2839) There are no Indians and nor any Coloured
employees African males are represented by 2603 (n=739) The same hospital has no
white female employees no Indians no Coloureds and 7395 (n=2097) African females
The table reflects a predominantly African female workforce The hospital is situated in a
rural setting and this may have an impact on the vast difference in the gender
representation
The Tara Moross Centre and Germiston Hospitals are located in cosmopolitan areas They
have 187 (n=5) and 1117 (n=5) White male employees respectively and 672 (n=18)
and 443 (n=19) female employees respectively Tara Moross Centre Hospital has 4 48
(n=12) female Indian employees while Germiston Hospital has only 024 (n=1) Germiston
Hospital has 723 (n=31) female Coloured employees while Tara Moross Centre has 150
(n=4) The core function of the various hospitals may have influenced the gender
distribution
TABLE 4 COMPARISON OF TENURE OF SERVICE IN RELATION TO ABSENTEEISM IN THE
FOUR HOSPITALS
TENURE IN YEARS DAYS OF ABSENCE PERCENTAGE
1ndash10 4451 30
11ndash20 6577 443
21ndash30 2934 198
31ndash40 878 59
TOTAL 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 4 reflects the level of tenure of the total workforce from 1 year to 40 years of service
Tenure of 11 years to 20 years of service reflects 443 (n=6577) utilisation of leave of
absence and remains the highest rate of absenteeism followed by tenure of 1 to 10 years of
service at a 30 absenteeism rate
44
TABLE 5 COMPARISON OF THE OCCUPATIONAL GROUPS IN THE DIFFERENT HOSPITALS
OCCUPATIONAL
CATEGORIES
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Doctors 12 12 354 19 397
Professional
nurse
47 81 548 109 785
Staff nurse 15 53 358 56 482
Nurse assistant 16 50 308 55 429
Social worker 4 4 8 3 19
Occupational
therapists
4 0 15 1 20
Radiographer 0 3 27 6 36
Clinical
Psychologists
4 0 10 2 16
Physiotherapists 0 1 9 1 11
Dieticians 0 0 5 3 8
Finance 4 11 59 9 83
Speech
therapists
0 0 5 1 6
Pharmacists 2 9 36 5 52
Dentists 0 0 0 3 3
Technicians 2 5 51 6 64
Librarian 1 0 0 0 1
Security 6 0 30 1 37
Administration
and support
151 200 1016 194 1561
TOTAL 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 5 reflects a great difference in terms of number of occupational groups in the four
hospitals
45
The core function and the size of the hospital seems to have a bearing on how many
occupational categories of employees are to be found in that hospital as well as the actual
figures of these categories The George Mukhari Hospital is an academic hospital that trains
medical doctors This hospital has 1247 (n=354) doctors in a staff establishment of
n=2839 Tara Moross Centre has 448 (n=12) in a staff establishment of n=268 Germiston
has 280 (n=12) in a staff establishment of n=429 and ODI District hospital has 401
(n=19) in a staff establishment of n=474 This trend of vast differences in figures
represented by the occupational groups is evident in the category of professional nurses
where George Mukhari Hospital reflects 1931 (n= 548) nurses Tara Moross Centre is
represented by 1754 (n=47) Germiston by 1889 (n=81) and ODI District hospital by
23 (n=109) The impact of absenteeism is pronounced when viewed against the level of
facility capacity in terms of human resources of the core occupational groups
441 The Tara Moross Centre Hospital
Tara Moross Centre Hospital is a speciality psychiatric hospital in Region A with a workforce
of 669 (n=268) of the total workforce (n=4010) The core function of the hospital is
specialised such that some occupational categories are not available in the hospital as part
of the workforce and patients are referred out to other facilities for specialised treatment
Tara Moross Centre Hospital falls under the jurisdiction of the Johannesburg Metropolitan
Municipality
442 The Germiston Hospital
Germiston Hospital is a regional general hospital in Region B with a total permanent staff
establishment of 1070 (n= 429) of the total workforce (n=4010) The hospital falls under
the Ekurhuleni Metropolitan Municipality It does not have occupational therapists clinical
psychologists dieticians speech therapists and dentists in its permanent staff
443 The ODI District Hospital
The ODI District Hospital is in Region C and is in transition due to boundary changes It is
being transferred from the North West Province to the Gauteng Province The hospital is in
a semi-rural area with a staff component of 118 (n=474) of full-time employees (n=4010)
and falls under Tshwane Metropolitan Municipality It is a general district hospital
444 The George Mukhari Hospital
The George Mukhari Hospital is an academic hospital in Region C under Tshwane
Metropolitan Municipality The hospital trains doctors and employs 010 (n=3) White male
employees 26 (n=739) African males and7184 (n=2097) African females out of the
total female workforce (n=2919)
46
This phenomenon may be as a result of the hospital having the highest general assistants
workforce at 2065 (n=586) out of the workforce (n=2839) The George Mukhari Hospital
has the highest number of general assistants out of the four hospitals represented as 25
(n=719) in a total workforce of n=2836 African employees
45 RESEARCH INTERPRETATION
The interpretation of leave of absence is confined to salary level 1 to 12 full time employees
of the Gauteng Department of Health who took leave of absence from the workplace for the
calendar year in 2008 It excludes the contract employees periodic remuneration foreign
employees and permanent employees above salary range 13
The Basic Conditions of Employment Act 75 of 1997 Section 9 (3) (RSA 1997) prescribes
procedures in terms of progressive reduction of the maximum working hours to the goal of
a 40-hour working week and an eight-hour working day Finnemore and Van Rensburg
(2002462) state that the reduction of maximum working hours to 40 hours a week is done
through collective bargaining with due regard to job creation efficiency and health safety
and welfare of employees Du Toit and Van Der Waldt (1998232) use the formula to
aggregate lost working-man hours due to ill health and disability as aggregate lost hours in
the survey period divided by 40 hours in a week and x number of hours in a year A formula
to work out the absenteeism rate by Pierce (2009) is represented as A=BC A= Absenteeism
rate B= Total number of days lost due to absenteeism in a given period C= Total number of
working- man days available in the given period C=D x E D=Total number of employees
planned to work in the given period E=Number of available working days in the given
period
The approach of the research uses the principle of absence from the workplace when due to
work to identify the lost working hours (Pierce 2009 Davey amp Cummings 2009313) The
study applies a retrospective approach
The working-man lost days for the Province in the four hospitals is approached in terms of
lost working -man days simplified refers to the number of days meant to have been worked
but actually not worked due to illness or disability by the employees in a year divided by the
total number of employees of the public sector (PXVI) Barker (200779) argues that a
reduction in working hours increases the hourly cost of production and unit production
unless there is a commensurate increase in productivity This approach has a similar effect
on workplace absenteeism when the workload of those employees who are present
increases as they carry the double load to meet the demands of service delivery The cost of
absence to the Province is expressed as salary expenditure for each day of leave of absence
from the workplace (PSC 2002 xiii Pierce 2009)
47
The salary range is laid down according to Annexure in DPSA Circular 1 of 2008 The Gauteng
Government experienced a cost estimated at R29 million in 2000 and approximately R54
million in 2001 from absenteeism and loss of working time (Parbhoo20031)
The formula that is used in this research to calculate lost man work-hours is collective
working days of absence multiplied by 8 hours in a working day resulting in the total
working hours that are lost This formula can be represented as
Lost days x hours (8) in a working day = lost working hours
As stipulated by the Basic Conditions of Employment Act 75 of 1997 section 9 1(c) 3
TABLE 6 RACES IN RELATION TO ABSENTEEISM
RACE TOTAL DAYS OF ABSENTEEISM PERCENTAGE
Africans 14295 963
Whites 242 16
Coloureds 201 14
Indians 102 07
TOTALS 14840 100
(Source Compiled by the researcher 2012)
Table 6 represents absenteeism in the diverse races in the workplace The absenteeism rate
seems to be proportional to the number of employees The Employment Equity Act 55 of
1998 defines the term ldquoblackrdquo as a generic term which means Africans Coloureds and
Indians The Africans as a race group is represented by 963 (n=14295) of the total
working days lost (n=14840) The high figure of lost working-man days reflects the
demographics of the four hospitals The George Mukhari Hospital is in a rural setting that is
predominantly African populated and employs the highest number of Africans as
represented in table 3 Whites are presented by 16 and not represented in all
occupational categories and salary ranges that could explain the low figures and
percentages associated with working-man days lost Africans constitute the highest number
of employees as well as the highest percentage of working-man days lost Absenteeism
percentage is proportional to the employment figures for this race group The Indian race
group is represented by the lowest figure of employment and lowest percentage of leave of
absence which is proportional to the employment figure
48
TABLE 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM
OCCUPATIONAL
GROUPS
TARA GERMISTON ODI GEORGE
MUKHARI
TOTALS
DOCTORS 22 118 5 290 435
PROFESSIONAL NURSE 272 346 20 2459 3097
STAFF NURSE 128 247 13 1568 1956
NURSE-ASSISTANT 150 126 25 1145 1446
FINANCE 0 0 0 386 386
ADMINISTRATION 57 272 20 1923 2272
ADMIN SUPPORT 754 547 163 3784 5248
TOTAL 1383 1656 246 11555 14840
(Source Compiled by C S Ndhlovu 2012)
Table 7 reflects the working-man days lost by the different occupational groups The
doctorsrsquo workload in terms of the annual report for Gauteng Department of Health
(2008951) was 226 as against the target of 227 while the national target was 187
The bed occupancy rate target for the same time was 75 while the actual figure was
653 The annual report interpreted in conjunction with the data of leave of absence for
doctors reflects a negative impact in terms of service delivery and the cost factor to the
department
451 Occupational groups in relation to absenteeism
The multi-group invariance structural model presents different types of occupations and is
used to identify variance in the patterns in terms of occupational groups The model allows
different relationships between variables in different occupations The different
occupational groups are doctors professional nurses and sub-categories administration
staff and administration support staff (Pousette amp Hanse 2002230) According to Gaudine
and Gregory (2010599) absenteeism was a problem among health care workers in
comparison to other employees in other sectors The cornerstone of an efficient health care
service delivery is equity and efficiency which is threatened when employees are not at
work when expected to be (Andrews 199734-35 DPSA 1997)
49
According to the Charted Institute of Personnel Development (200811) the survey that was
conducted found that public sector employees are less likely to be disciplined or dismissed
for reasons of workplace absenteeism
Tables 5 and 6 and 7 reflect the different occupational groups and the level of absenteeism
in the four hospitals of the Gauteng Department of Health
4511 Doctors
Doctors are represented by 10 (n=397) of the total working population (n=4010) The
29 (n=435) indicates the number of working-man days lost in relation to the total
working- man days lost (n=14840) The percentage of working- man days lost in relation to
the total number of full time employees of the four hospitals is reflected as 435 divided by
n=4010 times the percentage which results in 108 (n=435) working-man days lost
multiplied by 8 hours that represent a working day The outcome is n=3480 working-man
hours The cost to the Province is calculated in terms of the salary expenditure as direct and
indirect salary payment for lost working-man hours estimated at 3480 hours at salary level
10 at R217 482 to salary level 12 at R 407745 as well as indirect costs such as replacement
of staff and overtime
The doctorsrsquo workload in terms of Gauteng Province 20089 annual report (2008951)
reflects the doctorrsquos workload as 226 as against the target of 227 while the national
target is reflected as 187 The bed occupancy rate target for the same time is 75 while
the actual target rate is 653 The annual report when interpreted in conjunction with the
data of leave of absence for doctors reflects a negative impact in terms of service delivery
and the cost factor to the Department when considering a loss of n=3480 man hours of
work
Chaudhury and Hammer (200311) found in their research that the doctors presented the
highest absenteeism rate Serneels et al (2008210) argue that absenteeism is rife in the
public sector where employees hold two jobs and is highest among doctors The doctor
absenteeism rate in the research does not stand out as high in comparison with the other
occupational groups The doctor absenteeism rate is 29 when compared to the total
workforce This occupational group is represented by 10 of the total population The
doctorsrsquo absenteeism rate does not seem to be outstandingly high in comparison with the
other occupational groups in relation to the total number of permanent doctors
50
4512 Professional nurses
The professional nursesrsquo absenteeism is reflected as 208 (n=3088) that indicates the
number of working-man days lost in relation to the total working-man days lost (n=14840)
The percentage of working-man days lost in relation to the total number of full time
employees (n=4010) in the four hospitals is reflected as 77 The cost to the Province
translates into direct and indirect salary expenditure which is spread from salary level 4 to
12 at R64 410 to R407 745 in 2008 for the total duration of lost working days
Du Toit and Van Der Waldt (1998232) pointed out a crisis in four other public hospitals in
the Gauteng Province that was caused by budget cuts and shortage of doctors and nurses in
2008 The vacancy rate of 697 in the professional nurse category and the absence rate of
208 in 2008 in the four hospitals seem to point to a lack of adequate human resources for
effective health care delivery The extent of working-man hours lost in the findings of the
research suggest a high rate of absenteeism and not a good reflection of happiness as
suggested in the annual report Professional nurses are second to the administration
support in absenteeism at 208 at a total of (n=785) nurses in the four hospitals with
absenteeism of n=3088 working-man days lost or n=20704 working-man hours lost This
category of employees is classified as skilled to highly skilled at salary range of 4 to 12The
total vacancy rate was at 697 as against the national target at 15 in 2008 with
absenteeism of 208 Madibana (201022) found in the research about absenteeism
among nurses that the high rate of absence had a negative impact in the quality of health
care rendered by nurses
4513 Staff nurses
Staff nurses are reflected in tables 4 and 5 as representing 12 (n=482) of the total working
population (n=4010) The 132 (n=1956) indicates the number of working-man days lost
in relation to the total working-man days lost (n=14840) times the percentage
The percentage of working-man days lost in relation to the total number of full time
employees in the four hospitals is reflected as 488 The cost to the Department is
expressed as direct and indirect salary expenditure for n=15648 working-man hours lost
The impact of leave of absence to health care services and cost to the Department is the
same as the professional nurses as staff nurses are a sub-category of the nursing profession
4514 Nursing assistants
Nursing assistants are reflected in tables 4 and 5 as represented by 107 (n=429) of the
total working population (n=4010) and 97 (n=1446) represent working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The
percentage of working-man days lost is reflected as 36 (n=1446) in relation to the total
number of employees in the four hospitals (n=4010)
51
The cost of leave of absence to the Department is expressed as the salary expenditure at
salary levels 3 to 6 Salary level 3 is at R54 876 salary level 4 is at R64 410 salary level 5 at
R76 194 and salary level 6 is at R94 000 for n=11568 working-man hours lost and staff
replacement and overtime
4515 Finance officers
Finance officers are reflected in tables 5 and 7 as represented by 21 (n=83) of the total
working population (n=4010) and 26 (n=386) indicates the working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The cost to the
Department is reflected as salary expenditure from salary level 2 at R47 787 to salary level
10 at R217 482 for R2 728 working hours lost The institutions reflected a small number of
this occupational category as permanent employees place them in the category of scarce
skills
4516 Administration staff
The administration staff is represented in tables 2 and 4 and 5 by 116 (n=466) in the total
working population (n=4010) and 153 (n=2272) indicates the working-man hours lost in
relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 567 represent the working-man days lost in relation to the total number of
full time employees in the four hospitals (n=4010) The cost of leave of absence to the
department is reflected as salary expenditure at salary level 4 to 12 Salary 4 at R64 410 to
salary level 12 at R407 745 for 18176 working hours lost
4517 Administration support
The administration support is reflected in tables 2 and 4 and 5 as represented by 273
(n=1095) of the total working population 354 (n=5248) indicates the working-man days
lost in relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 1309 (n=5248) indicates the working-man days lost in relation to the total
number of employees in the four hospitals (n=4010) The total cost to the Department is
reflected as salary expenditure at salary level 2 to 3 at a cost of R47 787 to R54 879 for
41984 working -man hours lost
The highest percentage of absenteeism in the different categories of employees in the four
hospitals is identified in the administration support category It is this category that falls into
the salary range of 2 and 3 which is classified in the Gauteng Province 20089 annual report
(20089325) as lower skilled employees This category represents the highest single
category of employees for the Department at n=1095
52
The impact to the core service delivery employees that require support from administration
staff would seem to be negative as the absence of employees from the workplace would
hamper the smooth workflow Barker (2007214-224) acknowledges the decline in the flow-
through rate in the school education higher grades namely Grade 11 and Grade 12 and
ventures to give possible reasons for this phenomenon The Gauteng Department of Health
as a possible employer has attracted a high percentage of the labourer category as
identified in table 3 totalling n=1095 which is 273 of the total workforce Pousette and
Hanse (2002230-231) suggest that the employeersquos authority to make decisions in his or her
job and the breadth of use of skills used by the employees at work become different aspects
of control with human service at work This approach suggests that reduced job autonomy is
associated with higher sickness absence The administrative support employees are involved
in mechanical or manual labour that predisposes them to musculo-skeletal problems The
work environment could have a negative impact to the high absenteeism rate in this group
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM AS REPRESENTED BY
THE HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 43 reflects the absenteeism rate of the different occupational groups as represented
by the hospitals The George Mukhari Hospital contributes 7079 to the total workforce
and contributes about 779 to absenteeism The absenteeism rate does seem to be low at
7 when considered in the light of the contribution The question that maybe be raised is
whether the relative low absenteeism is indicative of high morale of a happy workforce
53
ODI 17
TARA 93
GERMISTON 111
GEORGE MUKHARI 779
Germiston Hospital contributes 106 to the total workforce and the absenteeism is
reflected as 111 which seems to be above its contribution to the workforce by 1 The
professional nurse and the administration category present with the highest rate of
absenteeism in this hospital The Tara Moross Centre Hospital contributes 67 of the total
workforce and the absenteeism rate is at 93 which is 26 higher The administration
support and professional nurses present with the highest level of absenteeism in this
hospital The ODI Hospital contributes 6 to the total workforce and the absenteeism rate
which seems to be low is reflected as 17 This hospital has no access to the Persal system
and is dependent to a neighbouring hospital It is highly probable that the information is not
accurate
Allen (1984 331) found that union members might be absent more frequently from the
workplace than non-members because they face smaller penalties for absenteeism The
Charted Institute of Personnel and Development (CIPD) (200811) claim that the 2006
survey of absence management portrays the public sector employees as less likely to be
dismissed for reasons of workplace absenteeism
TABLE 8 SALARY RANGE IN RELATION TO ABSENTEEISM (SALARY RANGE 1-12)
SALARY RANGE DAYS OF ABSENCE PERCENTAGE
1-2 178 12
3-4 5235 353
5-6 2044 138
7-8 5139 346
9-10 1878 126
11-12 366 25
TOTAL 14840 100
(Source Compile by the researcher C S Ndhlovu 2012)
Table 8 reflects the salary range with the lowest working days lost as salary level 1 to 2 This
is proportional to the number of employees The highest absenteeism rate has been noted
in the salary range at level 3 to 4 while salary ranges at level 11 to 12 reflected a low rate of
absenteeism The latter salary range is at middle management level and the responsibility
the employees carry may be responsible for the low absenteeism rate Rogers and Hertin
(1993219) noted that the level of education seem to have influenced the use of sick leave
where the lower level category employees were found to have higher level of absenteeism
than higher educated employees
54
TABLE 9 AGE IN RELATION TO ABSENTEEISM
AGE IN YEARS DAYS OF ABSENCE PERCENTAGE
20 to 24 16 010
25 to 29 405 272
30 to 34 733 493
35 to 39 1582 1066
40 to 44 2676 1803
45 to 49 3318 2235
50 to 54 3046 2052
55 to 59 2235 1506
60 to 64 829 558
TOTAL 14840 9999(100)
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 9 reflects age in relation to absenteeism in the four hospitals The age group at 20 to
24 years reflects the lowest figure in working-man days lost at 010 (n=16 days)
Reday-Mulvey (200579) observed that employees over 45 years take marginally fewer short
sick leave days per year than those under 45years
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 to 55 years
as middle -age and shows this group as presenting with a high incapacity leave usage In the
research the age group 45 to 49 years presented with 2235 (n=3318) working-man days
lost and is the highest figure of absenteeism in all age groups The age group at 20 to 24
years is reflected as the lowest absenteeism rate in working-man days at 010 and this
could be related to the number of employees in this age group
According to Reday-Mulvey (20057988) and the Canadian Nurses Association (20065)
employees that are over 45 years take marginally fewer short sick leave periods but take
slightly longer sick days per year than those under 45 years and reflect higher absenteeism
in the age group above 50 years
55
Weeks (200454) found that employees at the age group represented by 51 to 60 years
show less absence which may be because of ill health retirement benefits The age 31 to 40
and 41 to 50 years show higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full time jobs and suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee In the study the age group 55 to 59 years show a decline in absenteeism in
comparison to 50 to 54 while age 60 to 64 shows the lowest rate
The aging employee has been found to expose the institutions to high levels of absenteeism
through a higher probability of becoming incapacitated for longer periods (Ferguson et al
200138) and the current research have pointed differently Rogers and Hertin (1993219)
found a significant correlation between the use of sick leave and age suggesting employees
with advanced age used more sick leave in comparison with the younger employees The
current socio-economic culture encourages retirement from active employment at the age
of 65 years and the research adopted that approach as a cut off point for employment
(Nichols amp Evangelisti 2001285)
TABLE 10 GENDER IN RELATION TO ABSENTEEISM
GENDER TOTAL
NUMBER
DAYS OF
ABSENCE
PERCENTAGE
Males 1006 2490 168
Females 3004 12350 832
Total 4010 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 10 reflects gender in relation to absenteeism The duration of working-man days lost
is higher in female employees at 8325 (n=12350) and is represented by 749 (n=3004) in
relation to the total number of employees in the four hospitals (n=4010) as represented in
table 3 The male employees employed by the Department are reflected as absent from
work by 1680 (n=1006) and represented as 251 in relation to the total number of
employees in the four hospitals (n=4010)
The Public Service Commission (PSC 200222) found that more males took sick leave than
females except for the age group of 16 to 19 years QUALSA (200923) noted that females
had the highest number of incapacity applications in comparison to their male counterparts
Qualsa attributed this pattern to the fact that female employees constitute a higher
percentage of the employee population within the Gauteng Department of Health
56
Roger and Hertin (1993222) noted that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees could have an
impact on the high number of absenteeism reflected by the women
452 Race in relation to absenteeism
The working population of the four hospitals is represented by four race groups such as
Africans Whites Coloureds and Indians
4521 Africans
Africans represent 973 (n=3902) of the total working population (n=4010) and 963
(n=14295) indicates the working-man days lost in relation to the total working-man days
lost (n= 14840) times the percentage 3565 (n= 14295) reflects the working-man days
lost in relation to the total number of employees in the four hospitals (n=4010) The 14295
working-man days lost are multiplied by 8 hours that represent a day and translates into
963 (n=114360) working-man hours lost The cost to the Department is translated as
salary expenditure for n=114360 workingndashman hours lost and the indirect cost of staff
replacement and overtime Africans constitute the highest number of employees as well as
the highest percentage of working-man hours lost Absenteeism percentage is proportional
to the employment figures for this race group
4522 Whites
Whites are represented as 13 (n=51) of the total workforce (n=4010) and 16 (n=242)
represent the working-man days lost in relation to the total working-man days lost
(n=14840) times percentage 61 (n=242) represent working- man days lost in relation to
the total number of employees in the four hospitals The 232 working-man hours lost are
multiplied by 8 hours that represent a working- man day that translates into 16 (n=1856)
working-man hours lost The cost to the Department is represented as salary expenditure of
(n=1856) working-man hours lost that is paid to the unproductive employees This race
group of employees is not represented in all occupational categories and salary ranges
which may explain the low figures and percentages associated with working-man days lost
(n=242) The demographics of the different hospitals may contribute to the low
representation of this group in the total workforce
4523 Coloureds
Coloureds are reflected as 11 (n=43) of the total workforce (n=4010) 14 (n=201)
represent working- man days lost in relation to the total working- man days lost (n=14840)
5 (n=201) indicates working- man days lost in relation to the total number of employees in
the four hospitals (n=4010)
57
The cost to the department is represented as salary expenditure for n=1608 working-man
hours that are lost This race group is represented in three of the four hospitals and not in
all categories and salary ranges which may explain the low representation and
absenteeism
4524 Indians
Indians represent 03 (n=14) of the total workforce (n=4010) in table 6 07 (n=102)
represent working- man days lost in relation to the total working- man days lost (n= 14840)
times percentage 25 (n=102) indicates working- man days lost in relation to the total
number of employees in the four hospitals (n=4010) The 102 working- man days lost are
multiplied by 8 hours that represent a working-man day and translates into 07 (n=816)
working- man hours lost The cost to the Department is expressed as salary expenditure
paid to the unproductive employees for duration of (n=816) working-man hours lost This
race group is not represented in two of the four hospitals in some occupational categories
and salary ranges The Indian race group is represented by the lowest figure of employment
and lowest percentage of leave of absence which is proportional to the employment figure
FIGURE 44 RACES IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 44 reflects the different races in relation to absenteeism The Africans as a race
group is represented by 963 of working-man days lost (n=14840) The high figure of lost
working-man days reflects the demographics of the four hospitals
58
14840 DAYS
(100)
Africans 963
whites 16
coloureds 14
Indians 07
The George Mukhari Hospital is in a semi-rural setting that is predominantly African
populated and employs the highest number of Africans as represented in table 1 (n=2836)
Whites are presented by 16 absenteeism rate and not represented in all occupational
categories and salary ranges which could explain the low figures and percentages associated
with lost working days The absenteeism rate for Indians is represented as 07 and
Coloureds as 14
The Africans as a race group constitute the highest number of employees as well as the
highest percentage of working days lost Absenteeism percentage is proportional to the
employment figures for this race group The Indian race group is represented by the lowest
figure of employment and lowest percentage of leave of absence which is proportional to
the employment figure The South African Survey Millennium (1999-200028) reflected the
African males in 1998 as 354 and females as 348 the Coloured males as 39 and
females as 46 Indian males as 39 and females as 15 and White males as 83 and
females as 94 There has been no significant change in the race group representation in
the working population of the four hospitals
453 Tenure in relation to absenteeism
Tenure in years is grouped in units of ten (10) Tenure in 1 to 10 years 11 to 20 years 21 to
30 years 31 to 40 years of all occupational groups are represented in figure 27 as the total
leave of absence utilised by the full-time employees of different occupational groups in
terms of tenure which translates into n=14840 working-man days lost The lowest hours lost
is at tenure 31 to 40 years of service which is reflected as 59 (n=878) working- man days
lost The highest working-man days lost is at tenure of service of 11 to 20 years reflected as
443 (n= 6577) working- man days lost Tenure of service of 1 to 10 years reflects 30
(n=4451) working-man days lost and tenure of years at 21 to 30 years reflects 198 (n=
2934) working- man days lost
Rogers and Hertin (1993222) express tenure as work experience in years that is viewed as a
predictor of employee productivity where seniority has been found to be inversely related to
absenteeism in terms of frequency and total number of work days lost The Canadian Nurses
Association (20065) suggests that job tenure increases with age as illustrated in their
research where nurses were found to have both job tenure of 20 years or more and are over
45 years of age In the research the tenure of 31 years to 40 years presented with the lowest
absenteeism rate in agreement with Rogers and Hertin (1993222)
59
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 45 reflects the total leave of absence from tenure of 1 year to 40 years The PERSAL
system reflected 40 years as representing more or less 64 years of age and 65 years is the
cut off point for full time employees in the system The lowest working- man days lost is at
tenure of 31 to 40 years of service which is reflected as 590 and represents the older
employee in general The highest working- man days lost is reflected at tenure of 11 to 20
which is presented as 4430 representing the younger employee This is an area of concern
as table 5 reflects professional nursesrsquo absenteeism rate at 208 and administration
support staff at 356 and is possible that the absenteeism rate of the two occupational
categories may be a bigger contributor to the high absenteeism rate reflected in the tenure
of 11 years to 20 years
454 Salary range in relation to absenteeism
The salary range is interpreted in the study as a salary broad band that is represented in
table 9 and ranges from level 1 to 12 Rogers and Hertin (1993 219) claim that the level of
education does seem to have a bearing on the salary range use of sick leave where the
lower level category employees were found to have higher levels of absenteeism than the
higher educated employee The Human Resource Development Strategy (Gauteng Province
200815214) claims that the chances of entering into a higher income bracket in South
Africa rises noticeably after people have twelve years of education The ages 20 to 24 years
are greatly affected by this assumption
60
0
20
40
60
Tenure 1-10Tenure 11-20
Tenure 21-30Tenure 31-40
30 4430
1980
590
Tenure
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 46 above reflects the salary range from 1 to 12 in relation to working- man days lost
as salary range 1 to 2 as n=178 working-man days lost which converts to 12 The highest
absenteeism rate has been noted in the salary range at level 3 to 4 at 3530 (n=5235)
working-man days lost while salary ranges at level 7 to 8 is reflected as the second highest
level of absenteeism at 346 (n=5139) lost working-man days
Salary range at 5 to 6 is reflected as the third highest in absenteeism at 138 (n=2044) lost
working-man days Salary range 9 to 10 is regarded as the entry point to middle
management and is reflected as the fourth highest at 126 (n=1878) working-man days
lost Salary range at 11 to 12 is regarded as middle management entrusted with high levels
of authority and accountability This group is reflected as losing 25 (n=366) working- man
days lost which is considered to be a reasonable low level of absenteeism
455 Age of full time employees in relation to absenteeism
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 years to 55
years as middle-age and shows this group as presenting with a high incapacity leave usage
In the research the age group of 45 years to 49 years is represented with 2235 (n=3318)
working- man days lost and is the highest figure of absenteeism in all age groups
61
178
5235
2044
5139
1878
366
0
1000
2000
3000
4000
5000
6000
Salary range1-2
Salary range3-4
Salary range5-6
Salary range7-8
Salary range9-10
Salary range11-12
DAYS OF ABSENTEEISM
Reday-Mulvey (20057988) and Canadian Nurses Association (20065) observed that
employees over 45 years take marginally fewer short sick leave periods but take slightly
longer sick days per year than those under 45 years and reflect higher absenteeism in the
age group above 50 years
Weeks (200454) claims that the age group at 51years to 60 years show less absence may be
because of ill health retirement benefits The age group of 31 years to 40 years and 41years
to 50 years show a higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full-time jobs He suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee The aging employee has been found to expose the institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods
(Ferguson et al 200138)
Rogers and Hertin (1993219) claim that there is a significant correlation between the use of
sick leave and age suggesting employees with advanced age comparatively used more sick
leave in comparison with the younger employees The current socio-economic culture
encourages retirement from active employment at the age of 65years and the research
adopted that approach as a cut off point for employment (Nichols amp Evangelisti 2001285)
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 47 reflects the number of working-man days lost by full-time employees through
absenteeism related to a specific age
62
16
405
733
1582
2676
3318
3046
2235
829
0
500
1000
1500
2000
2500
3000
3500
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Days of absence
Days of absence
Age groups are organised in units of 5 to be consistent with the Personnel and Salary
Administration System (PERSAL) The age group at 20 years to 24 years reflects the lowest
percentage of absenteeism at 010 (n=16) working-man days lost and the age group of 45
years to 49 years reflect the highest days of absenteeism at 2235 (n=3318)
456 Gender in relation to absenteeism
The females employed in the Department of the four hospitals are represented as 749
(n=3004) in relation to the total number of employees in the four hospitals (n=4010) and
lost 8320 (n=12350) working-man days This absenteeism rate is considered high
considering that not every female employee may have used sick leave The male employees
employed in the Department are represented by 25 (n=1006) of the total workforce
(n=4010) and lost 168 (n=2490) working-man days The findings suggest that males
utilised fewer days of sick leave considering the fact that not every male employee may
have utilised sick leave for the duration of the study
The Public Service Commission (PSC 200222) claims that more males took sick leave than
females except for the age group of 16 years to 19 years QUALSA (200923) noted that
females had the highest number of incapacity applications compared to their male
counterparts Qualsa attributed this pattern to the fact that female employees constitute a
higher percentage of the employee population within the Gauteng Department of Health
Rogers and Hertin (1993222) argue that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees may have an
impact on the high rate of absenteeism
63
FIGURE 48 GENDER IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 48 reflects gender in relation to absenteeism The females employed by the
department in the four hospitals are reflected as absent from work at a rate of 8320
(n=12350) working-man days and represented by 749 (n=3004) in relation to the total
number of employees (n=4010) in the four hospitals The male employees employed by the
Department are reflected as absent from work at 1680 (n=2490) and represented as
251 (n=1004) in relation to the total number of employees in the four hospitals
(n=4010)
457 Week days in relation to occupational groups
Table 11 reflects the trends in terms of days of the week that show high utilisation by the
different occupational groups Mondays Fridays and Thursdays reflect a high utilisation rate
by the employees suggesting a pattern of high absenteeism rate over weekends
Professional nurses and sub-categories and the administration support group reflected the
highest absenteeism over the weekends
64
1680
8320
000
1000
2000
3000
4000
5000
6000
7000
8000
9000
Males Females
GENDER ABSENCE
TABLE 11 WEEK DAYS IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
OCCUPATIONAL
CATEGORY
MONDAY TUESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Doctors 18 8 13 17 0 0
Professional
Nurse
135 86 94 137 0 0
Staff Nurse 52 38 56 65 2 0
Nursing
Assistant
62 27 34 45 2 0
Administration
Staff
64 38 58 73 1 0
Administration
support
252 147 98 126 26 15
Finance officer 17 4 8 16 0 0
TOTAL 600(4) 348(23) 361(24) 479(32) 31(02) 15(010)
(Source Compiled by C S Ndhlovu 2012)
Table 11 reflects the pattern of how the different occupational groups utilised sick leave on
the different days of the week It illustrates the days that sick leave started on each day of
the week The largest number of incidences of sick leave commence on Monday the first
working day of the week as reflected by 4 (n=600) of the days of the weekend Fridays are
the second highest days of absenteeism represented by 32 (n=479) Tuesdays and
Thursday are almost the same in utilisation as reflected by 23 and 24 respectively
Professional nursesrsquo absenteeism was pronounced on Mondays as 2250 (n=135) and
Fridays as 2861 (n=137) a trend that shows possible long weekend absenteeism
The administration support staff has been reflected as mostly absent on Mondays 42
(n=252 days) and Fridays 2631 (n=126 days) The administration support reflected the
highest days of absenteeism on Saturday (n=26) and Sunday (n=15) The Canadian Nurses
Association (CNA) (2006) focused on seasonal pattern of absenteeism in the different
categories in the different hospitals The PSC (2002) report identified a trend by provincial
employees of using sick leave to extend their weekends The research considered working-
man days lost in terms of days of absence as in accordance with evidence of a medical
certificate Administration support is the only group that seem to have utilised Saturdays
for sick leave 8387 (n=26) and Sundays 100 (n=15) days
65
TABLE 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALS
INSTITUTIONAL
CONTRIBUTION
TARA MOROSS
CENTRE
GERMISTON ODI GEORGE
MUKHARI
TOTAL
Contribution to
Sample
668 1070 1182 7080 100
Contribution to
Absenteeism
842 1177 165 7816 100
(Compiled by C S Ndhlovu 2012)
Table 12 reflects the contribution of each hospital to absenteeism Tara Moross Centre
Hospital contributed 67 to the sample and the absence rate is higher than the
contribution at 84 The Germiston Hospital contributed 107 to the sample and the
absenteeism rate is higher at 117 The George Mukhari Hospital contributed 708 to the
sample and absenteeism rate is at 782 and ODI Hospital contributed 118 and
absenteeism rate is at 17 The latter hospital has no computers at The reflection of the
status of absenteeism is likely to be inaccurate The George Mukhari Hospital has the
highest contribution to the sample yet leave of absenteeism is tolerable It raises questions
as to what should be the contributory factor to the leave of absence status in this hospital
46 CONCLUSION
Chapter 4 presented the analysed data in terms of the characteristics as determined in the
stratified random sampling The characteristics and their association with absenteeism have
been presented such as occupational categories age gender tenure of service and race
The research identified which days of the week were utilised for sick leave absence The
contribution of each hospital to absenteeism was identified and a brief overview of each
hospital was presented
Chapter 5 presents the findings conclusion and recommendation of the research
66
CHAPTER 5
FINDINGS CONCLUSIONS AND RECOMMENDATIONS
51 INTRODUCTION
Chapter 1 provides a general introduction to the research It included the background and
motivation for the research that provides the context the problem statement and the
significance of the research The key concepts are defined The research design the method
of data collection the sampling method data analysis and interpretation and limitations to
the research are explained in this chapter
Chapter 2 considers the theoretical foundations concepts characteristics theories
approaches and classifications of workplace absenteeism The discussions on the conceptual
framework of absenteeism predictors of absenteeism and various models of absenteeism
are presented Measures to control workplace absenteeism and the impact of absenteeism
in an institution and management intervention strategies in workplace absenteeism were
discussed
Chapter 3 describes the research design and the different aspects of the research methods
that were applied to the research The chapter explains the various data collection
techniques that are used unit of analysis units of observations construct validity and
ethical considerations
Chapter 4 provides the organisational structure of the Gauteng Department of Health
comparisons of hospital employees different race groups of the four hospitals gender
comparisons in different hospitals and comparisons of the different occupational groups It
provides a short description of the target hospitals The research interpretation is discussed
in terms of the different occupational groups and absenteeism different races and
absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism The trends of week days of
absenteeism in the four hospitals and contributions to absenteeism by the four hospitals are
presented
Chapter 5 explains a synthesis of the study and evaluation of workplace absenteeism The
findings of the research and recommendations are discussed
52 FINDINGS
The findings of the research reflect doctors as represented by 108 in the total workforce
(n=4010) have an incidence of 29 (n=435) of the total work-man days lost (n= 14840) by
the employees in the four hospitals translating to a total of n=3480 working hours lost
67
The working-time lost is considered against the doctorsrsquo workload of 226 in contrast to the
target of as 227 while the national target was 187 The bed occupancy rate target was 75
while the actual figure was 653 The annual report when it is interpreted in conjunction
with the sick leave absence of doctors at 29 shows no negative impact on the workload in
terms of service delivery The negative impact is mainly on the cost factor to the state as the
doctorrsquos salary level is from salary level 10 at a cost of R217482 to salary level 12 at
R407745 (Gauteng Province annual report 2008951) Serneels et al (2008210) claim that
absenteeism occurs primarily in the public sector associated with people who hold two jobs
and that is highest and more frequent amongst doctors The findings of the research of
absence of 29 with a contribution of 2 to the sample are in disagreement with the
Serneels et al findings
Professional nurses represent 196 (n=785) of the total workforce (n=4010) The
workplace absenteeism is represented as 77 (n=3088) of the total workforce (n=4010)
translating into 21 of working-man days that are lost (n=14840) The absenteeism rate
appears to be very high given the fact that nurses by virtue of their numbers are the
backbone of health care service delivery (DPSA 2009) The Gauteng Province annual report
of 2008951 reflects the total vacancy rate of nurses at 697 as against the national target
of 15 The absenteeism rate of 77 is very high when compared with the total vacancy
rate and 19 contribution to the sample Staff nurses are a sub-category of the nursing
profession and the impact of their absence to service delivery is the same as the
professional nurses The findings of the study reflect staff nurses representing 12 (n=482)
of the total working force (n=4010) The absenteeism from staff nurses is reflected as 13
(n=1956) of the total working-man days lost (n=14840) The absenteeism rate does appear
to be high when considering the contribution of 13 to the absence rate by a sample of 12
to the total working-man days lost Nursing assistants are a sub-category of the nursing
profession that is reflected as 107 (n=429) of the total number of employees (n=4010)
and represent 97 (n=1445) of the total working-man days lost (n=14840) This absence
rate is considered as high when compared with the total number of employees
The nursing occupational group considered collectively contributed to absenteeism at the
workplace at 997 which is extremely high Davey and Cummings (2009312-313) claim
that frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased
staff morale and high cost to health care The high absenteeism rate has a negative impact
on health care service delivery
The findings of the research reflect administration staff as 116 (n=466) of the total
number of employees (n=4010) represented by 154 (n=2286 days) of the total working-
man days lost (n=14840) Administration support is at salary level 1 to 2 with exceptional
instances of salary level 3 to 4
68
Administration support staff is reflected as 273 (n=1095) of the total workforce (n=
4010) represented by 356 (n=5289 days) of the total working-man days lost (n=14840)
translating to n=42312 lost working-man hours
The administration staff viewed collectively contributed 51 to absenteeism which is very
high with the support staff reflected as 356 Rogers and Hertin (1993219) claim that the
level of education seem to have influenced the use of sick leave where the lower skilled
category of employees were found to have higher levels of absenteeism than higher
educated or skilled employees The findings of the research reflect the administration
support staff to be in line with the Roger and Hertin findings
The Gauteng Department of Health has a limited number of finance officers causing them to
be a scarce skill occupational group The finance officers represent 2 (n=83) of the total
workforce (n=4010) The working-man days lost are reflected as 23 (n=341) of the total
working-man days lost (n=14840) The total absence at 23 is higher than the actual
contribution to the sample at 2
The age group of 45 years to 49 years reflects the highest absenteeism rate at 224
(n=3318) the age group at 50 years to 54 years is reflected as 205 absenteeism The age
group 40 years to 44 years reflected as 18 absent from the workplace The age group of 55
years to 59 years is reflected as 15 absenteeism Employees of advanced age used more
sick leave in comparison with the younger employees This phenomenon could be attributed
to the ageing process of the body and the onset of incapacity Absenteeism has been found
to be higher in employees who are over 50 years of age and the phenomenon is attributed
to age and changing abilities that increase when work is performed full- time The findings
of the research reflect the age group over 50 years at 205 and reflect the highest
absenteeism rate at age 45 years to 49 years as 224 (McGoldrick amp Arrowsmith 200184
MINTRAC 20093 Nichols amp Evangelisti 2001285 Reday-Mulvey 200579-194) According to
Ferguson et al (200138) the aging employee presents with high levels of absenteeism
through higher probabilities of becoming disabled for longer periods The findings of the
study reflect absenteeism of the age group of 55 years to 59 years at 15 which is the
lowest in the age groups The Canadian Nurses Association in (20065) noted a reduction in
workplace absenteeism rate among nurses who are less than 45 years of age and an
increase in the absenteeism rate among nurses above 55 years of age According to Bangali
(20043-4) the falling rate of the older employee age group could be influenced by the
practice of early retirement or voluntary severance which was used in the 1990s as a
method of restructuring in institutions Rogers and Hertin (1993219) claim employees with
advanced age used more sick leave in comparison with the younger employees
69
The group at tenure 11 to 20 years presented with the highest level of absenteeism at
443 The employee at tenure of 21 to 30 years presented with 198 of absenteeism rate
while the employees at 1 to 10 years presented with the rate of 30 The findings of the
research reflected tenure of 31 to 40 years to have presented with the lowest absenteeism
rate at 59 (n=878 days) This low absenteeism rate could be ascribed to the fact that
numbers of employees are reduced in this group or could also be commitment to their jobs
or could have higher ambition levels to aspire to higher posts
Van Der Westhuizen (2006136) and Rogers and Hertin (1993222) express tenure as work
experience that may be viewed as a predictor of employee productivity where seniority has
been found to be inversely related to absenteeism in terms of frequency and total number
of working-man days lost The public service employees enjoy security of tenure which may
contribute to the unacceptably high levels of absenteeism (Andrews 1997221ndash222
MINTRAC 20093)
The findings of the research reflect females as 75 of the total workforce (n=4010)
represented by 832 (n=12350) of the total working-man days lost (n=14840) The males
represent 25 of the total workforce (n=4010) and are reflected as absent at 168
(n=2490) of the total days of absence (n=14840)The absenteeism rate is very high for
females in this research Rogers and Hertin (199322) and Van Der Westhuizen (2006136)
suggest that women are absent from workplace more than men are Landstad et al (20011)
found that women cleaners who received preventive personnel support depicted a
reduction in absenteeism rate Hoxsey (2010562) claims that although women presented
with a high score of job satisfaction than men they maintained higher levels of
absenteeism MINTRAC (20094ndash8) found that gender moderates the age turnover
relationship Women are more likely to remain in their jobs the older they get than men do
The findings of the research reflect Africans as represented by 26 of the working
population and utilised 963 of the total working-man days lost due to sick leave It is
possible that the overall number of Africans influenced what seems to be a high level of
absenteeism at 963 Whites represented 03 of the working population and
absenteeism is reflected as 16 of the total working-man days lost Coloureds are
represented by 03 of the working-man population and absenteeism was recorded as 14
of the working-man days lost The Indians are represented by 01 of the total working
population and are reflected as 07 of the working-man days lost
The findings of the research reflect the salary range at level 11 to 12 utilised 25 working-
man days for sick leave salary level 7 to 8 which is the supervisory level utilised 346
working-man days lost salary level 3 to 4 which is the entry level of skilled workers utilised
353 working-man days lost The findings suggest management used fewer days of sick
leave in comparison to the supervisory level and entry skilled worker level
70
This can be ascribed to the fact that they are ultimately responsible for the institutionrsquos
effectiveness and productivity
The George Mukhari Hospital contributed 708 to the sample and reflected 771
absenteeism which is relatively low in comparison to the size of the contribution It could be
that processes and procedures of controlling leave of absence are in place The Tara Moross
Centre Hospital contributed 67 to the sample and reflected 93 absenteeism rate that is
high by 26
Professional nurses reflected a trend of high absence over the weekend including
Thursdays This could be a sign of burn out and extending the period of rest from possible
high workloads resulting from high vacancy rates (Gauteng Province annual report 20089)
Nyathi (200059) and the PSC (2002) found that employees are absent from work because
they want to prolong the weekend
53 CONCLUSIONS
The absenteeism rate is very high for females in this research The aging employee presents
with high levels of absenteeism through higher probabilities of becoming disabled for longer
periods The use it or lose it approach of the current system rewards the abuse of sick leave
as it is viewed as not being beneficial by the employees to act responsibly towards the use
of sick leave
The vacancy rate of 697 in the professional nurse category and the absence rate of 208
in 2008 in the four hospitals can only suggest inadequate levels of human resource for
effective efficient quality health care services at a high cost to the Province The nurses
may not be aware of the actual absenteeism or they under-estimate it The combination of
high registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery
Professional nurses and administration support staff have absented themselves from the
workplace predominantly on Mondays and Fridays It could be for various reasons ranging
from feelings of burn out to extending the weekend
The percentage of working-man days lost in relation to the total number of full-time
employees in the four hospitals is reflected as 488 which is very high as there is no
deterrent not to abuse sick leave in the public sector The findings of the research found a
significant correlation between the occupation and use of sick leave age and the use of sick
leave gender and use of sick leave and tenure and use of sick leave
71
The biggest hospital George Mukhari presented the lowest rate of absenteeism for its size
and complexity which reflects an empowered management The Tara Moross Centre
Hospital is the smallest hospital highly specialised and presented with high rate of
absenteeism for its contribution which may be a reflection on the skills of its management
or the type of health care service that is offered by the institution
The international norm of absenteeism is 3 The research established the absence rate at
488 The Gauteng Department of Health is held at ransom by the five trade unions it has
signed agreements with and that makes it difficult for managers to manage absenteeism
The practise of Gauteng Department of Health Head office to remove managers from
institutions when there is a labour unrest exacerbates the problem of managing
institutions
The findings of the research could not establish a representative reflection of race and
absenteeism as Indians Coloured and Whites were not represented in some institutionsrsquo
demographics
54 RECOMMENDATIONS
The White Paper on Transforming Public Service holds management responsible for
delivering specific levels of services and for obtaining value for money in wider utilising of
resources This strategy is to be translated into action The Gauteng Department of Health
should probably benefit by adopting the total absence management philosophy by
cultivating a culture that is not tolerant of high levels of absenteeism through building it in
as a key performance area of the performance of all managers and all employees The
current performance dimension system should lay explicit emphasis on this aspect
The re-engagement of knowledge based and professional retirees at reasonable
remuneration levels to reward their expertise may assist in reviving good work ethics by
mentoring the new and generally young recruits The retired professionals are currently
resisting the call for re-employment on a contract basis at entry level
The Gauteng Department of Health can encourage flexitime in terms of 58 or 68 to allow
the mature employee to remain within the system with the view to share their knowledge
and skills with the young employees who may be highly qualified but lack experience This
approach may deal with the need for adequate human resources for health care delivery at
reduced cost as two employees on flexitime basis can occupy one full-time employeersquos post
Managers should use the return-to-work counselling strategy to solicit feedback from the
employee about the actual absenteeism The counselling should be on a one-to-one basis
This approach may raise self-awareness to the employees in terms of the impact of the
employeersquos absence frothed workplace
72
Currently this intervention strategy is not adequately utilised for fear of confrontation with
labour representatives
Managers should have attendance policies in place effectively communicate policies to
employees adhere to policies and procedures and use absence control strategies
consistently This approach will minimise the feeling of injustice by employees Currently the
human resource unit is challenged by a high staff turnover due to promotions from the
human resource area a situation that creates a vacuum and lack of continuity weakening
the process of empowering line managers by human resource practitioners This high staff
turnover may be controlled through upgrading of the human resource salaries as the
salaries fall out of the occupation service dispensation (OSD)
Managers in the public service are expected to be responsible and accountable for their
portfolios including management of leave of absence and should not shift it to the human
resource unit as is currently the practice It should be possible to charge a manager as an
accomplice for failing to manage the absence of employees where there is no evidence of
corrective remedial action where it has been warranted The researcher takes cognisance of
the fact that the public service is highly unionised and this approach may trigger industrial
action
The employer needs to revive on the job in-service education and training as a way of
imparting institutional values such as attendance at the workplace in partnership with
recognised labour representatives through bilateral and multilateral forums and through
institutional skills development committee which should be representative of all
stakeholders with the view to promote stability in the workplace and indirectly enhance
productivity and reduce workplace absenteeism Currently the bilateral multilateral and
skills development committees are inactive in the institutions that were targeted and
management seems to be intimidated by the militant labour representatives
High levels of absenteeism among some occupational groups do suggest a need for an active
employee assistance programmes at all hospitals Employee wellness committees are
currently inactive There is a sporadic intervention approach at some institutions where
PILIR Committees are active Employee assistance programmes should be budgeted for as a
standing on-going programme in all hospitals There is a need for a thorough research as to
why absenteeism remains high in the public service and focus on absenteeism broadly
73
BIBLIOGRAPHY
African National Congress 1994 A national health plan for South Africa Johannesburg
African National Congress
Allen SG 1984 Trade union absenteeism and exit-voice Industrial and Labour Relations
Review 37 (3 April)
Auriacombe CJ 2001 Guidelines for drawing up research proposals and preparing
thesesdissertations Pretoria University of South Africa
Amin S Das J amp Goldstein M (eds) 2008 Are you being serviced Newtools measuring
service delivery Washington DC The International Bank for Reconstruction and
DevelopmentThe World Bank
Andrews Y 1997 The personnel function University of Pretoria Kagiso Tertiary
Babbie E 1992The practice of social research6th edition California Wadsworth
Bamford L Klein amp Engelbrecht B 1999 How to monitor and address absenteeism in
district hospitals for sub-district support initiative for sub-district support Cape Town
KWIK-SKWIZ 25 Press Gang
Bangali A 2004 Are older workers genuine assets for economy Strategies and possibilities
for effective use of their human resource potentialTuebingen Eberhard Karls University
Barker F2007The South African labour market theory and practice5th edition Pretoria
Van Schaik
Bendix S 2000 Industrial relations in South Africa4th revised edition Lansdowne Juta
Bergdahl M 2001 How-Malrt minimises business with HR practices Human Resource
Development Gauteng College Regional Academy Leadership Journal 6
Breetzke A 2009 Managing absenteeism Available at httpwwwIrnetworkcoza
(Accessed on 05082009)
Brink H 1996 Fundamentals of research methodology for health care professionals
Kenwyn Juta
74
Brynard PA amp Hanekom SX 2005 Introduction to research in Public Administration and
related academic disciplines Pretoria Van Schaik
Burton JP Lee TW amp Holtom BC 2002The influence of motivation to attend and
organizational commitment on different types of absence of behavioursJournal of
Managerial Issues14 (2)
Buschak M Craven C amp Ledman R 1996 Managing absenteeism for productivity SAM
Advanced Management Journal6 (1)
Camp S amp Lambert EG 2005 The influence of organizational incentives on absenteeism
Sick leave use among correctional workers Available on
httpwwweascnoaagov(Accessed on22052009)
Canadian Nurses Association 2006 Trends in illness and injury ndashrelated absenteeism and
overtime among publicly employed registered nurses Canadian Nurses Association Ottawa
Available on httpwwwcna-aiicca (Accessed on 30032009)
Chaudhury Namp Hammer JS 2003Ghost doctors absenteeism in Bangladeshi health
facilitiesWorld Bank Policy Research Working Paper 3065 May Available
onhttpecoworldbankorg(Accessed on 10072011)
Charted Institute of Personnel and Development 2008Absence managementAnnual survey
report Charted Institute of Personnel and Development July Reference 4513 Available at
httpwwwcipdcouk (Accessed on 10072011)
Cloete JJ 2004South African public administration and management2ndimpression
Pretoria Van Schaik
Clark RL 2007The emergence of phased retirement economic implications and policy
concerns Ontario John Deutsch Institute for the study of economic policy
Dagmara S 2000Whorsquos minding the hospitals Absenteeism soars HampHN Hospitals amp
Health Networks 74 (4) April 14ndash143 Available at httpwwwoasisunisaacza(Accessed on
20072011)
Davey MMamp Cummings G 2009 Predictors of nurse absenteeism in hospitals a
systematic review Journal of Nursing Management 17 312ndash330 Available on httpO-
webebscohostcomoasisunisaacza (Accessed on 30072011)
Department for Public Service and Administration1997White paper on transforming public
service delivery Pretoria Public Service Commission
75
Department of Public Service and Administration 2007 Determination on working time in
the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Determination of leave of absence
in the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Policy and procedures on incapacity
leave for ill-health retirement (PILIR)Pretoria National Office
De Wit P 2006 Reasons for absenteeism in the Department of Defence Pretoria Tshwane
University of Technology
Du Toit Damp Van Der Waldt G 1998 Public management grassroots Cape Town Juta
Du Toit D Knipe A Van Niekerk D Van Der Waldt Gamp Doyle M 2001Service
excellence in governance Cape Town Heinemann
Du Toit D Bosch D Woolfrey D Godfrey S Rossouw T Christie S Cooper C Giles
G amp Bosch C 2003Labour relations law a comprehensive guide4thedition Durban
LexisNexis Butterworths
Erasmus B Swanepoel B Schenk H Van der Westhuizen EJamp Wessels JS 2005 South
African human resource management for the public service Pretoria Juta
European Foundation for the Improvement of Living and Working Conditions
(EFILWC)1997Preventing absenteeism at the workplace Ireland Office for Official
Publication on the European Committee
Fakie SA 2005Report on the Auditor-General on a performance audit of the management
of sick leave benefits at certain national and provincial departments Pretoria Department
Public Service and Administration (DPSA)
Ferguson T D Muedder Kamp Fitzgerald R M2001 The case of total absence
management and integrated benefitsHuman Resource Planning24 (3)
Finnemore M amp Van Rensburg R 2002 Contemporary labour relations Johannesburg
LexisNexis
Gaudine A amp Gregory C2010The accuracy of nursesrsquo estimates of their absenteeism
Journal of Nursing Management 18599ndash605
Gauteng Province 2007 Human Resource Development Strategy for Gauteng for Gauteng
maximizing human capital for shared growth Pretoria Government Printers
76
Gauteng Province 20089 Annual report Pretoria Government Printers
Gauteng Province 2010 Monitoring and Evaluation Policy FrameworkGauteng Provincial
Government Office of the Premier
Ghauri P Gronhaug Kamp Kristianslund I 1995 Research methods in business studies
England Prentice-Hall
Goldsmith Mamp Morgan H 2003 ldquoLeadership is a contact sport The ldquofollow up factorrdquo in
management development The 5th Annual Global Learning SummitResearched and
organised by SALVO 20ndash24Feb
Goldstein M2008Why measure service delivery Are you being serviced New tools for
measuring service deliveryEdited byAmin S Das Jamp Goldstein MWashington DCThe
International Bank for Reconstruction and DevelopmentThe World Bank
Griep RH Rotenberg L Chor D Toivanen SampLandsbergis P2010Beyond simple
approaches to studying the association between work characteristics and absenteeism
Combining the DCS and ERI modelsRoutledge Taylor amp Francis GroupWork ampStress 24 (2
April-June)179ndash195Available athttpwwwinformaworldcom (Accessed on 20072011)
Grogan J 2003 Workplace law 7 th edition Lansdowne Juta
Grogan J 2005 Dismissal discrimination and unfair labour practices Lansdowne Juta
Hirschfield RR Schmitt LPamp Bedeian GA2002 Job-content perceptions performance-
reward expectancies and absenteeism among low-wage public-sector clerical employees
Journal of Business and Psychology 16(4) Human Sciences Press Available on
rhirschfterryugaed(Accessed on 30032009)
Hoxsey D2010Are happy employees healthy employees Researching the effects of
employee engagement on absenteeismCanadian Public Administration53 (4) p551-
571Canada The Institute of Public Administration of Canada
Jacobs EJamp Roodt G 2011 The mediating effect of knowledge sharing between
organisational culture and turnover intentions of professional nursesSouth African Journal
of Information Management
Jankowitz E 1991Terminating for absenteeism practical labour management Rivonia IR
Data Publication 1(10)
Keese M2006 Live longer work longerDELSA Newsletter OECD Available at
httpwwwoecdorgelsemployment(Accessed on 10072011)
77
Lambert EG Camp SD Edwards Camp Saylor WG 2005 Here today gone tomorrow
back again the next day absenteeism and its antecedents among Federal Correctional
staffWashington DC Ohio
Landstad B Vinberg S Ivergard TT Gelin G ampEkholm J2001Change in pattern of
absenteeism as a result of workplace intervention for personnel support Ergonomics
001401391544 (1)
LexisNexis 2006Labour Law Reports July 1994ndashDec2006CumulativeIndex Durban
LexisNexis
LexisNexis 2007 Legislation and strategyLexisNexis (9)Durban Butterworths Available at
httpwwwmylexisnexiscoza (Accessed on 15072011)
Madibana LF 2010 Factors influencing absenteeism amongst professional nurses in
London Pretoria University of South Africa
Markussen S Rogeberg OJ amp Gaure S 2009 The anatomy of absenteeism IZA
Discussion Paper Series No 4240 June Bonn Institute for the Study of Labor
McCormick ET amp Ilgen D1985 Industrial and organizational psychology 8th edition New
Jersey Prentice-Hall
McGoldrick E amp Arrowsmith JJ 2001Discrimination by age the organizational response
Ageism in work and employment Edited by Glover IampMohamed Sterling Management
SeriesEngland University of Sterling
Mellor N Arnold Jamp Gelade G2009The effects of transformational leadership on
employees in four of UK public sector organisations Health and Safety Laboratory for the
Health and Safety Executive UK RR648 Research Report
MINTRAC 2009 Literature review on labour turnover and retention Available at
strategieswwwmintraccom (Accessed on 14042009)
Mouton J2005How to succeed in your Masterrsquos and Doctoral studies a South African guide
and resource book Pretoria Van Schaik
Munro L 2007 Absenteeism and presenteeism possible causes and solutions The South
African Radiographer45(1) Available onhttpsorsaorgza(Accessed on 10072011)
Nel PS Gerber PD Van Dyk PS Haasbroek GD Schultz HB Sono TampWerner A
2001 Human resource management5th edition New York Oxford
Nel PS Kirsten M Swanepoel BJ Erasmus BJampPoisant P 2008South African
employment relations theory and practice6th edition Pretoria Van Schaik
78
Nichols AampEvangelisti W2001 Fitness for work the effect of aging and the benefits of
exerciseSterling management series ageism in work and employmentEdited by Glover
LampMohamed B England University of Sterling
Nyathi MN 2000Factors contributing to absenteeism among nurses a management
perspective Pretoria University of South Africa
Patrick MN 2001Positive psychological functioning among civil servantsPretoria
University of South Africa
Paton N2010 Long-term absence hand in hand Occupational Health Reed Business
Information UK Reed Elsevier Available athttpebscohostcomoasisunisaacza
(Accessed on 10072011)
Parbhoo S2003 Why worry about absenteeism in the workplace CCMA PublicationCCMA
Mail July
Pierce K2009 The impact of absenteeism in the public service in the context of GEMS
Pretoria GEMS Government Employees Medical Scheme [lsquoslrsquo]
Public Service and Co-ordinating Bargaining Council (PSCBC) 2000Resolution 72000
Polit DF amp Hungler BP 1995 Nursing research principles and methods Philadelphia
Lippincott
Pousette A amp Hanse JJ 2002Job characteristics as predictors of ill-health and sickness
absenteeism in different occupational types-a multigroup structural equation modelling
approachNational Institute for working life TaylorampFrancisSweden Goteborg Available on
httpwwwtandfcouk (Accessed on 10072011)
Public Service Commission2002Sick leave trends in the Public Service Pretoria Public
Service Commission
QUALSA Report 2009Policy procedure incapacity leave and ill-health retirement Steering
Committee QUALSA [rsquoslrsquo]
Reday-Mulvey G 2005Working beyond 60 key policies and practices in Europe New York
Palgrave Macmillan
Republic of South Africa 1995 Labour Relations Act 66 of 1995
Republic of South Africa 1997 Basic Conditions of Employment Act 75 of 1997
Republic of South Africa 2001 Public Service Regulation 2001
79
Republic of South Africa 2011 ldquoTowardsquality care for the patientrdquo National Core
Standards for Health Establishments in South Africa Pretoria Government Printers
Robbins SP amp Decenzo DA 2001 Fundamentals of management essential concepts and
applicationsNew Jersey Prentice Hall
Robbins SP Odendaal A amp Roodt G2004Organizationalbehaviour Global Southern
perspective 5th impression Cape Town Pearson
Rogers RE amp Hertin SR 1993Patterns of absenteeism among government employees
Public Personnel Management22 (2)Available at httpwwwquestiacom (Accessed on
10012009)
Serneels P Lindelow MampLievens T2008Qualitative research to prepare quantitative
analysis absenteeism among health workers in two African countriesAre you being
serviced New tools for measuring service deliveryEdited by Amin S Das
JampGoldsteinM2008 The International Bank for Reconstruction and DevelopmentThe
World Bank for Reconstruction and Development Washington D C The World Bank
Slabbert JA amp Swanepoel BJ 2001Introduction to employment relations
managementDurban Butterworths
South African Survey Millennium1999-2000 Johannesburg South African Institute of Race
Relations
Steers RMamp Rhodes SR 1978Major influences on employee attendance a process
model Journal of Applied Psychology63 (4)391-407
Oi-ling S2002Experience before and throughout the nursing careerPredictors of job
satisfaction and absenteeism in two samples of Hong Kong nursesJournal of Advanced
Nursing 40 (2)218ndash229 Available on httpwwwebscohostcomoasisunisaacza
(Accessed on 10072011)
Todd C2001Contract of employment Claremont Siber Ink
Tonya TW2001Minimizing absenteeism in the workplace strategies for nurse managers
Nursing Economics19 (2 MarApril) 53 3 Available at httpwwwoasisunisaacza
(Accessed on 14012009)
Tustin C 1994Industrial relations a psychological approach1st edition Halfway House
Southern Publishers
80
Unruh Jamp Strickland M2007 Nurse absenteeism and workload Negative effect on
restraint use incident reports and mortality JANORIGINAL RESEARCH Journal compilation
Florida Blackwell
Van der Westhuizen C 2006Work related attitudes as predictors of employee absenteeism
Pretoria University of South Africa
Venter R 2003 Labour relations in South AfricaRevised edition Cape Town Oxford
University Press
Viviane IJ 2011Absenteeism among women workers in industry85 IntrsquoLab Rev 248
(1962) Available at httpwwwHeinonlineorg(Accessed on 18052012)
Weeks KL 2004 Development and initial characteristics of a comprehensive survey on
workplace absenteeism Logan Utah State University Available on
httpwwwoasiscomunisaacza(Accessed on 14012009)
Welman JC amp Kruger SJ2001Research methodology for the business and administrative
sciences 2nd edition New York Oxford
Yende PM 2005 Utilising employee assistance programmes to reduce absenteeism in the
workplace JohannesburgUniversity of Johannesburg
81
ANNEXURES A B C
ANNEXURE A
PROCESS EVALUATION QUESTION COMPLIANCE
YESNO
ACTION PLAN
Retention and Reward -
leave
1 Are there complete and
accurate Z 1(Leave application
forms) forms on file
2 Have all application forms been
approved stamped and
registered
3 Have all forms been captured
on the Persal with the following
requirements
Supporting documents
A 10 day compulsory leave
processed within the annual
leave cycle Determination of
Leave
4 The remaining days are utilized
6 months from the end of the
leave cycle
5 Are there unutilized leave days
6 Has there been adequate
checking of leave reasons
Leave credits
Adherence to leave categories
(i)Normal ( ii) Incapacity
(iii) Injury on duty (iv) Maternity
(v)Adoption (vi) Family
responsibility
(vii) Office bearersshop stewards
and Casual Employees
7 Have work reasons been
provided for leave days
(Source Compiled by C S Ndhlovu 2012)
82
ANNEXURE B
Retention and
reward ndashsick leave
Evaluation Question Compliance YesNo Action Plan
1 Are there medical
certificates that have been
submitted to all medical
claims with the following
Specific illness stated
Supporting documents on
file
2 Has the 8 week rule for
36 days in a 3 year cycle
been adhered to
3 Are there complete
medical certificates for 3
days or more sick leave
days for normal sick leave
4 Are all other leave days
above 3 days utilized after
36 days treated as
temporary incapacity
leave
5 Are temporary
incapacity leave forms
submitted within 5 working
days after the first day of
absence
6Is there a register for
temporary incapacity
leave for 1 to 29 days lead
time for reporting leave
applications
7 Has the employer
approveddeclined the
leave application within 30
working days of receipt
(Source Compiled by C S Ndhlovu 2012)
83
ANNEXURE C
CHECK LIST
Is there a leave register in place for all leave applications
1 Is leave approved prior to the employee proceeding on leave
2 Area attendance registers maintained and up to date
3 Are periodic audits for leave carried out
4 Is there evidence of GSSCrsquos approval on leave applications
5 Are leave forms accurately captured on Persal
6 Are leave forms accurately completed by applicants
7 Is movement of leave forms monitored between the GSSC and institutions
8 How is rejected leave application dealt with
(Source Compiled by C S Ndhlovu 2012)
84
DECLARATION
I declare that Absenteeism in the Gauteng Department of Health is my own work and that
all the resources that I have used or quoted have been indicated and acknowledged by
means of complete references
Name C S Ndhlovu
Studentnumber 0-417-427-5
Date 11 June 2012
Signature ----------------------------------
II
ABSTRACT
The research is a quantitative descriptive survey The sample is a stratified random sampling
of the workforce (n=4010) of the four hospitals in Gauteng that fall under the jurisdiction of
Tshwane Ekurhuleni and Johannesburg Metropolitan Councils The research examines the
extent of the impact of age gender occupation salary level tenure and race on workplace
absenteeism The data were collected in three phases involving auditing of hard copy files
structured interviews and information technology system
The findings of the research reflect high workplace absenteeism in females by 832 age
group between 45 to 49 years by 2235 salary range of 2 to 3 by 353 African race group
by 963 tenure of 11 to 20 years by 443 nurses by 208 and administration support by
354 The research found that the mature employee in age and of higher year of tenure
presented comparatively with lower rate of absenteeism
Key words
Workplace absenteeism workplace absenteeism employee abscondment and desertion
employment relationships leave cycle quality standard
III
ACKNOWLEDGEMENTS
This work is dedicated to my late son Neville Ndhlovu my loving husband Errol Ndhlovu
who has been my pillar of strength my son John Ndhlovu for the unwavering
encouragement throughout this tough journey my nuclear family without whose support
during the grieving period I would not have completed this research I would like to
acknowledge my daughter-in-law Vuyelwa Ndhlovu and my lovely grandchildren Nhlamulo
and Ntsako Ndhlovu who are the sunshine of my life who allowed me to work on
ldquoProfessorrsquos workrdquo as they referred to the research I thank God who made it possible for
me to stay on track during the darkest hour in my life
I wish to extend my sincere gratitude to Professor Pauw who believed in me my
supervisor Professor S B Kahn who remained a beacon of hope during the most trying time
in my life Professor S B Kahn and my joint supervisor Mr A Van Schalkwyk offered valuable
professional guidance that ensured that the research met the required academic standard
I wish to extend my sincere gratitude to Mrs Marti Gerber who dedicated herself editing
this document
I am aware that there are others who also assisted in different ways whom I might have
omitted to mention in my acknowledgement who made it possible for me to complete the
task at hand The quality of your efforts and assistance is evident in the final product May
God bless you all in your generous efforts towards completion of this research
IV
GLOSSARY
ANC = African National Congress
BCEA=Basic Conditions of Employment
CNA=Canadian Nurses Association
CAT= Catastrophic Model
CIPD= Charted Institute of Personnel Development
CCMA = Commission for Conciliation Mediation and Arbitration
CSRS=Civil Service Retirement System
DPSA=Department of Public Service and Administration
EAP= Employee Assistance Programme
EFILWC=European Foundation for the Improvement of Living and Working Conditions
FERS=Federal Employees Retirement System
GDoH=Gauteng Department of Health
GHP=Gross Health Product
HRIM=Human Resource Information Management
HRDS=Human Resource Development Strategy
RSA=Republic of South Africa
PILIR=Policy and Procedures on Incapacity Leave for Ill-Health Retirement
PERSAL= Personnel Remuneration Administration System
PSCBC=Public ServiceCo-ordinating Bargaining Council
PTO= Paid Time off Model
PSC= Public Service Commission
SACOB=South African Chamber of Business
V
Table of Contents
1 CHAPTER 1 GENERAL INTRODUCTION 1
11 INTRODUCTION 1
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH 1
13 PROBLEM STATEMENT 2
14 AIM AND OBJECTIVES OF THE RESEARCH 2
141 Aim 2
142 Objectives 2
15 LITERATURE REVIEW 3
16 TERMINOLOGY 3
17 RESEARCH DESIGN AND METHODOLOGY 4
171 Research design 4
172 Methodology 5
173 Unit of analysis 7
174 Unit of observation 7
18 CONSTRUCT VALIDITY 7
19 ETHICAL CONSIDERATION 7
110 LIMITATIONS OF THE RESEARCH 8
111 STRUCTURE OF THE RESEARCH 8
112 REFERENCE TECHNIQUEhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip9
113 CONCLUSION 9
2 CHAPTER 2 MANAGING ABSENTEEISM 10
21 INTRODUCTION 10
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM 10
221 Classification of absenteeism 15
222 Definition of key concepts 15
23 EMPLOYMENT RELATIONSHIPS 17
231 Employment relationship as a multi-dimensional phenomenon 17
2311 Economic dimensions 17
2312 Legal dimension 18
2313 Individual dimension 18
2314 Collective dimension 19
2315 Psycho-social dimension 19
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM 19
25 PREDICTORS OF ABSENTEEISM 20
26 A MULTI-GROUP INVARIANCE MODEL 22
27 CATASTROPHIC MODEL (CAT) 24
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM 24
VI
281 Measuring absenteeism 25
29 IMPACT OF WORKPLACE ABSENTEEISM 25
291 Cost to the institution 26
292 Low productivity 27
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM 27
2101 Effective communication 28
2102 Empowerment of managers 28
2103 Monitoring of workplace absenteeism 29
2104 Visits to facilities 30
2105 Incentive system 30
2106 Team support 31
2107 Return-to-work interviews 31
2108 Employee assistance programme (EAP) 32
2109 Occupational and safety committee 32
21010 Review committeehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip33
211 CONCLUSION 33
3 CHAPTER 3 METHODOLOGY IN RESEARCH 34
31 INTRODUCTION 34
32 RESEARCH DESIGN 34
321 Methodology 34
33 UNIT OF ANALYSIS 36
34 UNIT OF OBSERVATIONS 36
35 CONSTRUCT VALIDITY 36
36 ETHICAL CONSIDERATIONS 37
37 CONCLUSION 37
4 CHAPTER 4 INTERPRETATION AND ANALYSIS OF DATA 38
41 INTRODUCTION 38
42 THE STRUCTURE OF THE ORGANISATION 38
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY 39
44 COMPARISON OF HOSPITALS PERMANENT EMPLOYEES 40
441 The Tara Moross Centre Hospital 46
442 The Germiston Hospital 46
443 The ODI District Hospital 46
444 The George Mukhari Hospital 46
45 RESEARCH INTERPRETATION 47
451 Occupational groups in relation to absenteeism 49
4511 Doctors 50
4512 Professional nurses 51
4513 Staff nurses 51
VII
4514 Nursing assistants 51
4515 Finance officers 52
4516 Administration staff 52
4517 Administration support 52
452 Race in relation to absenteeism 57
4521 Africans 57
4522 Whites 57
4523 Coloureds 57
4524 Indians 58
453 Tenure range in relation to absenteeism 59
454 Salary range in relation to absenteeism 60
455 Age of full time employees in relation to absenteeism 61
456 Gender in relation to absenteeism 63
457 Week days in relation to occupational groups 64
46 CONCLUSION 66
5 CHAPTER 5 FINDINGS CONCLUSIONS AND RECOMMENDATIONS 67
51 INTRODUCTION 67
52 FINDINGS 67
53 CONCLUSIONS 71
54 RECOMMENDATIONS 72
BIBLIOGRAPHY 74
ANNEXURES A B Chelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip82
VIII
LIST OF FIGURES
FIGURE 21 CONCEPTUAL FRAMEWORK MODELhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
FIGURE 22 MODEL SPECIFICATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
FIGURE 41 INTEGRATED ORGANISATIONAL STRUCTUREhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip53
AS REPRESENTED BY THE HOSPITALS
FIGURE 44 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip58
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip60
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip61
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALShelliphelliphelliphelliphellip62
FIGURE 48 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip64
X
LIST OF TABLES
Table 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
Table 2 COMPARISONS OF NUMBERS OF ADMINISTRATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
AND SUPPORT STAFF IN THE DIFFERENT HOSPITALS
Table 3 GENDER COMPARISON IN DIFFERENT HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Table 4 COMPARISON OF TENURE OF SERVICE IN RELATION TOhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
ABSENTEEISM IN THE FOUR HOSPITALS
Table 5 COMPARISON OF THE OCCUPATIONAL GROUPShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip45
IN THE DIFFERENT HOSPITALS
Table 6 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip48
Table 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Table 8 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip54
(SALARY RANGE 1-12)
Table 9 AGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip55
Table 10 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Table 11 WEEK DAYS IN RELATION TO ABSENTEEISM INhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip65
THE FOUR HOSPITALS
Table 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphellip66
IX
CHAPTER 1
GENERAL INTRODUCTION
11 INTRODUCTION
The Gauteng Province is viewed as a province of opportunities by South Africans as well the
neighbouring countries such as Mozambique and Zimbabwe The impact of these
perceptions has placed a heavy demand on services including health provided within the
confines of the province the results being an increase in the workload of the employees
The indirect results of the increase in the workload have been unacceptably high levels of
absenteeism seemingly sub-standard levels of health care and high cost of delivering the
health care services Absenteeism poses a threat and can lead to the collapse of health care
services if absenteeism is poorly managed The research examines the management and
control of absenteeism in four out of thirty four hospitals that service the province The
hospitals that have been targeted for the research are ODI District Hospital Germiston
Hospital TARA Moross Centre Hospital and George Mukhari Hospital
This chapter explains the background and motivation for the research The research
highlights the problem statement which focuses on the effective management of
absenteeism The objectives of the study the research methodology and structure of the
research are explained The relevant literature review was consulted for the research The
key concepts that are used in the research are conceptually defined The research design is
a descriptive stratified random survey The data that were used were collected in three
phases the unit of analysis were the employees of the Gauteng Department of Health in the
four target hospitals and the unit of observations were observations of the employees of
the four hospitals The construct of validity was achieved through using a variety of data
collection methods Ethical considerations were taken into account during the research
process Limitations of the research were imposed by the uniqueness of each of the target
hospitals The structure of the research and the reference technique is explained in this
chapter The research on absenteeism in the Gauteng Department of Health is confined to
the period of 1 January 2008 to 31 December 2008 and focused on the working-man days
lost how absenteeism is managed and employee well-being and rehabilitation
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH
The Gauteng Department of Health received a qualified report in 2008 on the control of sick
leave A performance audit was conducted by the Public Service Commission (PSC) (2002
xvi) into the information required to effectively manage sick leave in the public service
1
The research on absenteeism in Gauteng Department of Health seeks to examine the extent
of workplace absenteeism in the ODI District Hospital which is in a transitional stage from
North West to the Gauteng Province The hospital falls under Tshwane Metropolitan
Municipality and is in Region C The Germiston Hospital falls under Ekurhuleni Metropolitan
Municipality in Region B TARA Moross Centre Hospital is in Region A under the
Johannesburg Metropolitan Municipality and George Mukhari Academic Hospital is Region C
under the Tshwane Metropolitan Municipality The research seeks to examine the degree of
compliance by the four hospitals with the recommendations of the performance audit of
management of sick leave in the light of the qualified report received by the Gauteng
Department of Health (Human Resources) in 20089
13 PROBLEM STATEMENT
The Gauteng Department of Health provides health care services as the core business of the
Department The Health care services are labour intensive and high levels of absenteeism by
its employees undermine the Departmental efforts to deliver quality health care to the
people of Gauteng The problem statement therefore is to examine to what extent the
effective management of absenteeism can enhance the effectiveness of the Gauteng
Department of Health
14 AIM AND OBJECTIVES OF THE RESEARCH
The aim and objectives of the research are explained in this section
141 AIM
The aim of the research is to determine how the effective management of absenteeism can
contribute to the effective health care of Gautengrsquos communities
142 Objectives
The objectives of the study are
to determine the impact of the variables such as age gender occupational category
and salary level on workplace absenteeism
to determine whether the correlation between absenteeism levels and tenure of
service does exist
to determine trends of workplace absenteeism in different employee categories and
to establish the different challenges confronting the different hospitals in
management and control of absenteeism in terms of size complexity and location
2
15 LITERATURE REVIEW
Various studies have been conducted to examine workplace absenteeism in different fields
in government and private institutions Van Der Westhuizen (200636) research focused on
high and low combinations of job involvement and organisational commitment The
outcome was not emphatic on the findings as predictors of the turnover and absenteeism
The research noted that women are more absent from the workplace than men De Wit
(2006) focused on the nature of absenteeism the impact of absenteeism on the
organisation reasons for and causes of absenteeism and measurement of absenteeism and
the findings were not able to find a high coefficient in the test sample
Camp and Lambert (20054) found that the use of sick leave as an incentive to reduce sick
leave by the employees under the Civil Service Retirement System (CSRS) led to a reduction
of absenteeism as a result of sick leave when compared with employees who functioned
under the conditions of the Federal Employees Retirement System (FERS) who within the
same company lost the unused sick leave when they retired
Ferguson Ferguson Muedder and Fitzgerald (200138) focused on the impact of
absenteeism and cost in terms of time lost in the Total Absence Management (TAM)
concept and found that the aging employee exposes institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods of
time
Serneels Lindelow and Lievens (2008210) claim absenteeism is high among employees in
the public sector in developing countries due to a lack of accountability and a lack of
punishment for transgression
The research seeks to determine the extent of the problem of workplace absenteeism its
impact and management in the identified hospitals It seeks to establish the relationship if
any between the various variables and absenteeism such as age occupation tenure salary
level gender and race
16 TERMINOLOGY
Key concepts that are used in the research are conceptually defined however a
comprehensive concept clarification will be done in chapter 2
Workplace absenteeism Workplace absenteeism is the absence of employee at the
workplace that is defined by Du Toit and Van Der Waldt in (1998139) as the place that the
institution makes available and where officials have to perform their work
3
Workplace forms part of the internal environment for public administration in the public
service Robbins Odendaal and Roodt (200415) define absenteeism as the failure of an
employee to report for work as scheduled regardless of the reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work According to
Venter (2003267) desertion occurs when the employee leaves the place of employment
without the intention to return to work
Employee An employee is defined as any person employed in terms of the Public Service
Act 1994 irrespective of rank or position (Public Service Act 1994 Subsection 15) Todd
(20011) refers to an employee as any person excluding an independent contractor who
works for another person and is entitled to be paid for it or who in any manner assists in
carrying on or conduct the business of the employer Bendix (2000123) defines an
employee as a person in a workplace except a ldquosenior managerial employeerdquo whose status
and contract of service grants the employee the authority to represent the employer in
interactions with the workplace forum to determine policy on behalf of the employer and
make decisions which might conflict with representation of workers at the workplace
Employer An employer as an individual person who may be the employer in legal terms as
well as the organisation which is responsible for implementing Public Service human
resource management policies (RSA 1997 Section 15)
Leave cycle The Public Service Act 1994 refers to the leave cycle as 36 months employment
with the same employer
Quality Is defined as getting the best results possible within the available resources (RSA
2011)
Standard Is a statement of an expected level of quality delivery A standard reflects the
ideal performance level of a health establishment in providing quality care (RSA 2011)
17 RESEARCH DESIGN AND METHODOLOGY
This section deals with the research design and methodology
171 Research design
Research design is the overall plan for relating the conceptual problem to relevant empirical
research It is a quantitative descriptive research that involves the systematic collection of
numerical information under conditions of considerable control (Polit amp Hungler 1994
24175)
4
The choice of the research design influences subsequent research activities such as
identifying the target subjects what data to collect and how they should be collected The
research design is a descriptive stratified random survey which is concerned with
characteristics of a specific population subject at a fixed point in time for comparative
purposes The focus is on a representative sample of the relevant population It is concerned
with the accuracy of the findings and their generalisability The survey is used to gain deeper
insight of the behaviour of employees with regards to motivation satisfaction and
grievances (Babbie 199289 Ghauri Gronhaug amp Kristianslund 199527 60 Brink 199611
6 Welman Kruger amp Mitchell 200152)
172 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services Four hospitals of the thirty four health care delivery institutions have been
identified for the research
Each hospital is unique in its character in terms of specialisation of health care delivery
service The four hospitals are located in Tshwane Johannesburg and Ekurhuleni
Metropolitan Municipalities The sample is a stratified random sampling which is composed
of various clearly recognisable non-overlapping sub-populations (strata) that differ from
one another mutually in terms of variables that are a combination of more than one
variable such as age sex income level or educational level The purpose is to ensure that
every part of the population (every stratum) is represented The members of a particular
stratum are homogeneous in the population at large The sample is representative of a
population with clearly distinguishable strata with a greater degree of certainty (Babbie
199267 Brynard amp Hanekom 200544 Ghauri et al 199578 Brink 1996138 Welman amp
Kruger 200155-56 Welman et al 201061 Polit and Hungler 199518) The data were
collected in three phases
The first phase of data collection was done through auditing of hard copies of identified
personnel files representing ten files per hospital and using the tool in annexure A amp B The
forty employeesrsquo profiles were accessed through the Human Resource Information
Management system (HRIM) located in the Gauteng Department of Health Head Office The
respective employeesrsquo profiles were handed over to the human resource manager in the
respective hospitals on the morning of the audit for the human resource practitioner to
draw out the hard copy files for auditing The characteristics of the individuals that were
identified for the first phase were males and females and the different race groups The
auditing of the files was for the complete working life of the employees and not confined to
2008 only Registers that are used by the human resource administration to control the
movement of the leave forms were inspected as evidence of the control system in place
5
The purpose of auditing the files is to gain insight into how leave in general was captured
managed and controlled by the hospitals The second phase of data collection was done
through structured interviews with the four human resource managers who were directly
accountable for management and control of leave of absence in general in the four
hospitals
A structured interview provides for a more organised approach and a more stable basis for
assessment of the different candidates (Erasmus Swanepoel Schenk Van der Westhuizen amp
Wessels 2005250) The structured interview was conducted using the tool in annexure C
Tara Moross Centre Hospital had been functioning without a manager in human resource
and the manager that was interviewed had been in the post for three months The human
resource practitioner who was at salary level 8 acting in the Assistant Directorrsquos post
(manager) was invited to join the manager and be part of the structured interview ODI
District Hospital had three human resource practitioners including the accounting officer at
level 8 and in an acting capacity
The third phase of data collection was through the Human Resource Information
Management (HRIM) This system used Personnel Remuneration Administration System
(PERSAL) to collect data Data in this system are categorised in salary level date of
appointment occupational category gender age in units of five race employing hospital
employment status in different categories such as session contract and full-time and the
different types of leave of absence
The research used primary and secondary data in analysing sick leave utilised by full time
employees in the identified hospitals for the period of 1 January to 31 December 2008 using
the Personnel Remuneration Administration System The total population sample was four
thousands and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range at level 1 to 12
The research used past events such as sick leave utilised by employees using secondary
data from Personnel Remuneration Administration System falling into the category of a
historical empirical research The interval scale of measurement was used in the
quantitative research and actual numbers are ordered with equal measurement between
each category (Brink 1996 149 Brynard amp Hanekom 2005 28-29 Mouton 2005
52100170)
6
173 Unit of analysis
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the research refers to observation of work attendance by
the employees of Gauteng Department of Health in the four hospitals
The observation deals with the historical events such as employees who have already
utilised sick leave in the workplace The subjects that are studied are the core health care
providers such as doctors nurses and support employees such as allied administration and
administration support (Mouton 200551-52 Welman et al 2001 52-53)
174 Unit of observations
The observations that are made are of health care workers and support teams in Tara
Hospital Germiston Hospital ODI Hospital and George Mukhari Hospitals The unit of
observations describes the characteristics of a large number of individual people such as
gender age salary range occupational category tenure of service and race in relation to
absenteeism in the workplace In the descriptive research the individual characteristics are
aggregated for the purpose of describing a larger group (Babbie 199292)
18 CONSTRUCT VALIDITY
Construct validity is concerned with the question what construct is the instrument actually
measuring(Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with the four accounting officers in leave management The third phase was collecting of
personnel data through the Persal system
19 ETHICAL CONSIDERATIONS
Ethical considerations included among other issues the protection of the unit of analysis and
unit of observations from discomfort and harm by not revealing information which can
cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity Anonymity is achieved
when the researcher cannot link a given response with a given respondent and reporting
aggregate data only When data are collected at one sitting and not over a period of time
makes it possible to achieve anonymity as the need for follow up is eliminated Subjects of
observations are selected for reasons directly related to the problem being studied as the
principle of justice
7
Confidentiality is about the researcherrsquos responsibility to protect all data gathered within
the scope of the research and shared only with people involved in the research (Babbie
1992465ndash466 Brink 199640ndash41 45)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous The interview was part of the actual audit
that was done as part of monitoring and evaluation that was in progress in the Department
of Health following a negative auditor generalrsquos report about management of leave in
general The managers were put at ease as they were given the check list afterwards for
self-monitoring for future self-auditing
The data that were collected through Personnel Remuneration Administration System
(Persal) identified employees through the Persal number and kept their identity anonymous
The data that were collected through the hard copy of employeesrsquo files were used to point
out areas of concern to the managers and the files did not leave the office of the manager
at the end of the process once more protecting the identity of the employee
110 LIMITATIONS OF THE RESEARCH
The research was conducted on four hospitals of different sizes specialisation and three
metropolitans with unique challenges The period of the research was confined to a
calendar year (2008) and not a financial year The focus was on absenteeism due to sick
leave of full time employees There is no distinction that is drawn between the working-man
days that are lost between shift and non-shift workers The findings may be different if all
absenteeism of employees at the time were considered for the research
111 STRUCTURE OF THE RESEARCH
Chapter 1 It provides a general introduction to the research It includes an introduction the
background and motivation for the research that provides the context the problem
statement and the significance of the research The key concepts are defined The research
design the method of data collection the sampling method data analysis and
interpretation limitations to the research are explained in this chapter
Chapter 2 This chapter considers the theoretical foundations concepts characteristics
theories approaches and classifications of workplace absenteeism Conceptual framework
of absenteeism predictors of absenteeism and various models of absenteeism are
explained Measures to control workplace absenteeism the impact of absenteeism in the
institution and management intervention strategies are explained
Chapter 3 It describes the research design different aspects of the research methods
applied and the data collection techniques used unit of analysis units of observations
construct validity and ethical considerations
8
Chapter 4 This chapter provides the organisational structure of the Gauteng Department of
Health comparisons of hospital employees different race groups of the four hospitals
gender comparisons in different hospitals and comparisons of the different occupational
groups It provides a short description of the target hospitals The research interpretation is
discussed in terms of the different occupational groups and absenteeism different races
and absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism
The week days absenteeism pattern and contributions by the four hospitals to absenteeism
are presented in this chapter
Chapter 5 It provides a discussion of the research evaluation of workplace absenteeism
findings recommendations and limitations
112 REFERENCE TECHNIQUE
The reference technique that is applied in the research involves all sources that have been
consulted while doing the research When legislation is used as a source of information
reference to the specific act is used
113 CONCLUSION
Chapter 1 provides a discussion on the background and motivation of the research problem
statement and the objectives The significance of the research in South African public
institutions and private institutions of other countries and the possible contribution of the
study are explored The terminology that is used in the research is contextualised for the
purpose of the research The research design and methodology are presented in this
chapter The units of analysis the units of observation construct validity ethical
considerations and limitations to the research are also presented in this chapter
The next chapter discusses the theories of absenteeism
9
CHAPTER 2
MANAGING ABSENTEEISM
21 INTRODUCTION
The Gauteng Department of Health is classified as a public institution whose existence is
justified on the grounds that it renders health care services to the public The health care
system is encouraged to develop delivery systems and practices that are in line with
international standards management practices that promote efficient and compassionate
delivery of services and ensures respect for human rights and accountability to the public
(African National Congress 199443-44) This objective can only be achieved if the resources
to provide such services are available The human resources are a vital factor for the health
care sector as it is labour intensive Public institutions such as the Gauteng Department of
Health are funded from public funds and if the human resources do not report for work
service delivery is compromised and the cost to the department in the form of salary
expenditure becomes exorbitant as the department must find replacement staff and pay
for overtime as well It is when all these factors are taken into consideration that workplace
absenteeism becomes a cause for concern for the Gauteng Department of Health
In this chapter absenteeism is discussed from a theoretical perspective and informed by
literature review The classification of workplace absenteeism theoretical perspective
definitions dimensions of employment relationship conceptual framework of absenteeism
structural model of absenteeism legislative framework that regulates the employment
relationship and intervention strategies to control workplace absenteeism are explored
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM
According to Viviane (20111) the term absenteeism was first used in Britain during the
First World War in dealing with employed persons It is during the times when production is
of pressing national importance that the absence of employees from the workplace is keenly
felt Absenteeism is considered a good barometer of staff morale an indirect measure of
employeesrsquo health and well-being and is found to be associated with health-related
absences from work Employees who are motivated and committed to their work and
employer have to be very sick before they book off sick (Griep Rotenberg Chor Toivanen amp
Landsbergis 2010179)
McCormick and Ilgen (198556-57) describe job attendance criteria as relating to a tendency
of employees to withdraw from or attend to their jobs The criteria identified were job
tenure occupational category absenteeism and tardiness According to Markussen
Rogeberg and Gaure (20096) employee characteristics such as age gender education and
occupation have a substantial impact on absence behaviour
10
Chaudhury and Hammer (20033) identified that medical skills and nursing skills are
marketable and greatly in demand Doctors and nurses used this opportunity to make
money and work as private health care providers as well as public health care providers
holding two jobs The absence is considered in terms of morning or afternoon absence by
these categories as they are viewed as having a great deal of discretion over where and
when to discharge their public responsibilities The criteria identified were job tenure
absenteeism and tardiness
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) refer to absenteeism
as non-attendance when an employee is scheduled to work The theoretical perspective of
absenteeism takes into account the physical and or psychological absence of the employee
from the workplace or work station at a time when the employee is contractually expected
to be at the workplace According to Andrews (199734-35) the behaviour and actions of
public officials are determined by specific ethical codes of conduct and it is assumed that
their actions are for the benefit of the communities that are serviced by the public officials
Social ethics focus on how the clients of the Department are treated and are therefore
concerned with the impact of decisions on people inside and outside the institution
individually and collectively
Grogan (2005237) states that employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
look for trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
2001 section F(c) In the public sector contractual employee benefits are modified by
collective agreements These benefits are material gains for the employees and have a
monetary value and a cost factor to the employer
The contract of employment often includes insured benefits such as incapacity ill health
and early retirement as the total package other than the remuneration for the time worked
as it is intended to attract retain and motivate employees (Breetzke 20091 Ferguson et al
200137 LexisNexis 2006670 LexisNexis 2007176 Markussen Rogeberg amp Gaure 20093
Tustin 199452) The policy on Determination on Leave of Absence requires a medical
certificate for sick leave of three or more days and for every sick leave day utilised when the
eight week rule has been transgressed (DPSA 2009 Section 14 subsection 147)
Political ideologies influence the work environment resulting in some areas being highly
unionised where unions are perceived to be capable of exerting control over the employer
and employee relations for the primary benefit of the employees
11
It is the work environment which is highly unionised that is characterised by high workplace
absenteeism (Andrews 199736 Breetzke 20091 Du Toit amp Van Der Waldt 1998170139
Tustin 199452) Allen (1984331) claims that union members might be absent more
frequently from the workplace than non-members because they face smaller penalties for
absenteeism According to Markussen et al (20095 21) workplace environments do have an
impact on absenteeism and are influenced by social interaction processes among
colleagues Absenteeism is affected by social norms Workplaces with high employee
turnover rate tend to have high absenteeism The turnover rate is defined on a quarterly
basis as Min (number of entries number of existing persons) divided by the number of
employees at the start of the quarter The Charted Institute of Personnel and Development
(CIPD) (200811) claim that the 2006 survey of absence management portrays the public
sector employees as less likely to be dismissed for reasons of workplace absenteeism A
report by the National Institute of Labour Studies (Tonya 20011) found the rate of
absenteeism increased among full-time employees from 2 4 to 25 within two years
The services that are provided by the Department of Health are divided into two distinct
categories Direct services are those services that are rendered to the clients who are
patients who receive medical treatment from the core employees usually referred to as line
functionaries Direct services can only become effective and efficient when supported by
the services of the support staff that provide indirect health care services When employees
do not present themselves for work when scheduled to work and do so on a regular basis
the situation becomes habitual absenteeism (Du Toit amp Van Der Waldt 199818) The
Gauteng Department of Healthrsquos core function is to provide health care services to the
people of Gauteng Province The provision of health care services is labour intensive and
requires large numbers of personnel for effective service delivery
The workplace which may be physical or virtual for the public service employees represent
the internal environment of the institution The employer who is represented by the
manager determines the workplace for employees
Rogers and Hertin (1993217) explain the Decision Model Theory as a conscious decision by
the employee to stay away from work or come to work based on which motivation is
stronger at that moment It is not based on the ability to come to work
Serneels et al (2008210) claim that absenteeism is rife in the public sector especially where
employees hold two jobs The actions of public officials in the performance of their duties
should be ethically justified as it impacts on the decisions of people within and without the
institution individually and collectively Tension and job insecurity in the workplace
manifests as absenteeism (Andrews 199733-137)
12
Frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased staff
morale and high cost to health care (Davey amp Cummings 2009312-313) It is suggested that
on average health care workers are likely to be absent from work as a result of illness or
injury rather than other occupations Dagmara (20002) states that absenteeism may be a
benchmark of what is happening in the hospital setting Absenteeism is defined as habitually
not coming to work when scheduled to It is an indicator of psychological medical or social
adjustment to work
Absenteeism is measured by frequency or duration of work-days missed Frequency
measures provide a reasonable index of voluntary absenteeism whereby each incidence or
episode of absence is counted regardless of the duration of absence It is defined as the
number of days absent over a given period of time Other measures used were total days
duration and percentage Duration measures provide an index of involuntary absenteeism
such as time lost index To assess absence duration the total number of days is tallied
regardless of the number of incidents (Davey amp Cummings 2009313) High workload is
identified as one of the factors that affect absenteeism rate among health care workers
(Oi-ling 20023)
Workplace absenteeism is costly for an institution in terms of lost working-man days hiring
of staff to close the shortage absent or sub-standard service delivery and poor quality of
services The total cost of employment risk approach is about the estimation of the possible
cost of any absent employee to an institution per hour The annual cost to the institutions
per employee is in terms of direct and indirect costs such as overtime low productivity and
a decline in morale among workers who are expected to cover for an absent employee
(Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
The public service employees enjoy security of tenure which may be a contributory factor
of absence from work without good cause This practice is fostered by the knowledge that
they cannot be easily dismissed from their jobs therefore have the belief it is right to stay
away from work Misuse of sick leave is considered to be an overriding problem in instances
where the employee does not uphold the standard of honesty and incorruptibility or these
values are not considered to be the corporate values and norms of the institution (Andrews
1997 221-222 MINTRAC 20093)
Bangali (20043-5) describes age function in the sociological theory as a natural
characteristic of human beings but also an integral aspect belonging to the structure of the
society The age definition in the labour market is influenced by the structural functionalism
The employees age is categorised in the workplace in terms of functions to be performed
be it physical or intellectual The age group of 35 years to 49 years old employees comprise
the largest age group in the labour market
13
The employees who are less than 20 years of age reflect the highest absenteeism rate while
employees above 50 years of age reflect a decrease in the absenteeism rate The
disadvantage of the older workers is that their disabilities last longer once they are injured
and are more likely to be absent as frequently and more likely to be injured than younger
workers Keese (20062) states that ageism is evident in the public service and describes the
age group 25 years to 49 years old as prime age Rogers and Hertin (1993219) found a
significant correlation between the use of sick leave and age Employees with advanced age
used comparatively more sick leave in comparison with the younger employees The
Canadian Nurses Association (20065) noted a reduction in workplace absenteeism rate
among nurses who are less than 45 years of age and an increase in the absenteeism rate
among nurses above 55 years of age
Camp and Lambert (20054) found that the use of sick leave retention as an incentive to
reduce use of sick leave by the employees under the Civil Service Retirement System (CSRS)
leads to a reduction of absenteeism as a result of sick leave compared to the Federal
Employees Retirement System (FERS) who within the same company lost the unused sick
leave when they retired The Employees Retirement System (FERS) applies the same
principle of handling sick leave as the Gauteng Department of Health in the sense that
unused sick leave is forfeited at the end of the three year cycle (DPSA 2009Section 14)
Unruh and Strickland (2007674) found that absenteeism from the workplace does
contribute to a vicious cycle of a negative work environment which leads to more
absenteeism and increased turnover Absenteeism has been found to be higher in
employees who are over 50 years of age and the phenomenon is attributed to age and
changing abilities that increase when work is performed on a full time basis Part-time
arrangements reduce absenteeism as well as the cost of paying for a senior employee even
if seniority is just in tenure Age has been linked to a negative turnover in an institution The
older employee is less likely to leave the organisation An institution is healthier for a spread
of ages Some organisations consider employees to be older in batches or cohorts of five
such as 40 years to 44 years up to 64 years (Nichols amp Evangelisti 2001285 McGoldrick amp
Arrowsmith 200184 MINTRAC 20093 Reday-Mulvey 200579-194)
MINTRAC (20094-8) states that gender moderates the age turnover relationship Women
are more likely to remain in their jobs the older they get than men do Turnover is
occasionally related or preceded by high workplace absenteeism The occupational category
is linked to skill levels and salary levels The lower skill employees are concentrated in the
lower skill occupations and easily replaceable
14
Hirschfield Schmitt and Bedeian (2002553) conducted a research on low-wage public
sector clerical employees and found that those employees who perceived limited
performance-reward expectancies were likely to be absent more often The link between
skilled employees and absenteeism suggested that employees may have utilised
absenteeism as a means of compensating for perceived workplace contributions not
extrinsically rewarded
According to Gaudine and Gregory (2010599) the Canadian Institute for Health Information
(2007) found that absenteeism was a problem among health care workers in comparison to
other employees in other sectors Unruh et al (2007673) found the combination of high
registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery Markussen et al (200921) claim that the type of occupation an
employee is engaged in has an impact on absenteeism
221 Classification of absenteeism
The employees of the Gauteng province and their attendance at work are the focal point of
the province in relation to service delivery that is customer focused Health care services are
labour intensive and require employees to be at work when scheduled to do so (Gauteng
Province 201015) Workplace absenteeism can present in different forms and levels as a
result of a combination of variables (Andrews 19975 Breetzke 20091) McCormick and
Ilgen (198557) and Davey and Cummings (2009313) classify absenteeism as voluntary
when the absence is based on the conscious decision by the health care giver to withhold
contractual services The absence is uncertified unauthorised and unexcused while
involuntary absenteeism occurs for reasons beyond the control of the health care giver
such as illness injury or family responsibility Employers are challenged with the task of
differentiating between the absence due to elective workplace absence and absence due to
illness incapacity The differentiation is based on whether the illness incapacity is validated
by a legitimate medical certificate in terms of the prescript of section 23 of the Basic
Conditions of Employment Act (BCEA) 75 of 1997 (RSA 1997)
222 Definition of key concepts
Concepts are defined for common understanding in the context of the study
Workplace absenteeism Workplace absenteeism is absence of the employee at the
workplace that is defined by Du Toit and Van Der Waldt (1998139) as the place that the
institution makes available and where officials have to perform their work It forms part of
the internal environment for public administration in the public service Bamford Klein and
Engelbrecht (199911) refer to absenteeism as employees taking time off that has not been
scheduled
15
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) claim that
absenteeism is non-attendance when an employee is scheduled to work The European
Foundation (199711) views absenteeism as temporary or permanent incapacity for work as
a result of sickness or infirmity According to Robbins Odendaal amp Roodt (200415)
absenteeism is a failure of an employee to report for work as scheduled regardless of the
reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work The employee
should actually intimate expressly or by implication the intention not to return to work
According to Venter (2003267) desertion occurs when the employee leaves the place of
employment without the intention to return to work
Employee The Basic Conditions of Employment Act no 75 of 1997 Section 1 (a) (RSA 1997)
and Todd (20011) refers to an employee as any person excluding an independent
contractor who works for another person and is entitled to be paid for it or who in any
manner assists in carrying on or conduct the business of the employer The courts use the
control test which identified employees on the basis that they were part of the employer
organisation Bendix (2000123) claims that an employee is a person in a workplace except a
senior managerial employee whose status and contract of service grants the employee the
authority to represent the employer in interactions with the workplace forum to determine
policy on behalf of the employer and make decisions which might conflict with
representation of employees at the workplace Du Toit Bosch Woolfrey Godfrey Rossouw
Christie Cooper Giles and Bosch (200368) state that an employee is a person who works
for a single employer in a permanent fulltime capacity is subject to the supervision of the
employer and receives regular monthly or weekly remuneration and is obliged during
working hours to place his or her productive capacity at the employerrsquos prescribed disposal
Employer
Bendix (2000129) defines an employer as any person except an independent contractor
working for another person or the State and who receives remuneration or any manner
assists in carrying out or conducting the business of an employer DPSA (PILIR) (20094)
states that an employer is the Head of Department or a designated office which will be
responsible for the handling and investigation of incapacity leave applications and ill- health
retirement applications
16
23 EMPLOYMENT RELATIONSHIPS
The employment relationship is about balancing the simultaneous convergent and divergent
interests of the employer and the employee in a regulated manner with the aim of getting
the work of the institution done According to Erasmus et al (2005442) an employment
relationship exists when an individual is employed by someone else to be available to work
for that person in exchange for some remuneration It is through this employment
relationship that reciprocal rights and obligations are created between the employer and
the employee The employment relationship is conflictual in nature (Andrews 199736) The
employees through this relationship are enabled to gain access to the rights and benefits
associated with their employment The Labour Relations Act no 66 of 1995 (RSA 1995)
regulates the management of the conflict in the employment relationship through dispute
resolution structures such as the Commission for Conciliation Mediation and Arbitration
(CCMA) Labour Court and Labour Appeal Court when internal processes fail to resolve the
conflict The employment relationship can be traditional or typical and terms and conditions
of service of employment are regulated by collective agreements This is a tacit
acknowledgement of the existence of a typical employment relation
231 Employment relationship as a multi-dimensional phenomenon
Industrial relations and human resource management are bound together by the
employment relationship through labour employer and industrial relation triangle The
employment relationship is characterised by various dimensions as is the case in a broader
society The dimensions are economic legal individual collective and psycho-social (Grogan
200347)
2311 Economic dimensions
The economic dimension arises through the provision of labour by the employee in the form
of skill knowledge energy abilities and productive time to the employer in exchange for
remuneration Barker (200779) states that a reduction in working hours increases the
hourly cost of production in a unit unless there is a commensurate increase in productivity
The economic dimension is highly regulated The contract of employment includes insured
benefits such as incapacity ill health and early retirement The tendering of services by the
employees is a prerequisite to the employeersquos right to claim remuneration (Grogan
200347) According to LexisNexis (2007176) and the Public Service Regulations 2001
Section E E1 the actual contractual benefits are modified by collective agreements in the
public service sector Employee benefits are material gains for employees that have
monetary value and are a cost factor to the employer The Public Service Regulation 2001
Section F (a) states that the Head of Department shall promote economic and efficient use
of resource to improve the functioning of the public service (RSA 2001)
17
According to Ferguson et al (200137) and Erasmus et al (2005380) employee benefits are
the total compensation package other than the pay for time worked offered to employees
either partially or completely funded by the employer contributions In 2006 about R19
billion was lost on account of absenteeism from sick leave (LexisNexis 2006670 Patrick
2001 17)
Employee benefits are intended to attract retain and motivate employees Some of the
benefits offered to employees are mandated by law such as minimum leave provision as
contained in the Basic Conditions of Employment Act 75 of 1997 and Resolution 72000 of
the Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
2312 Legal dimension
The Labour Relations Act 66 of 1995 Section 3 of Schedule 8 requires that while employees
should be protected from arbitrary action employers are entitled to satisfactory conduct
and work performance from their employees The legal framework provides for the
regulatory requirements for human resource management in the working environment
Grogan (200347) and Grogan (2005120) view the employment relationship as formalised
by a legally binding agreement which is the contract The contract is regulated by specific
laws and formal rules with all the inherent rights and responsibilities to the employer and
the employee In terms of the employment contract one of the responsibilities of the
employee is to render service to the employer at specified agreed upon time except where
the employer has authorised the absence of the employee from the workplace Employees
have a fundamental duty to render services and the employer has a right to expect the
employees to tender such services A basic element of the duty to render service is that the
employee must be at the workplace at the specified agreed upon times unless there is
adequate reason to be absent Bendix (2000120) states that a contract is subject to the
terms and conditions of collective agreements The contract is subject to automatic changes
whenever a new collective agreement is in place The contract and its inherent benefits are
breached by elective absence behaviour of the employee The legal dimension has an
impact on the individual dimension
2313 Individual dimension
The employee enters into a working contract with the employer on an individual basis The
contents of the contract are subject to the Basic Conditions of the Employment Act 75 of
1997 The terms and conditions of employment in the public service are subject to collective
bargaining and collective agreements which influence the employment contract in the
Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
18
The contract of employment is entered into between the employer and the employee under
the supervision of the employer and for remuneration purposes
2314 Collective dimension
According to Slabbert and Swanepoel (20017) the collective dimension of the employment
relationship refers to the organised group aspect of the employment relationship which is
between labour as a group and employers and or their representative public sector
institutions The collective dimension aspect of employment relationship pertains to
legislation relating to bargaining dispute resolution and industrial action
2315 Psycho-social dimension
The psycho-social dimension of the employment relationship represents the unexpressed
needs and expectations of the employer and employees It refers to behaviour in the public
sector institutions within the context of the collective dimension (Davey amp Cumming 2009
313 Erasmus et al (2005442) The Public Service Regulation 2001 Section B states that the
Head of Department shall determine the working time of employees and take into
consideration their personal circumstances which have a social dimension (RSA 2001)
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM
Davey and Cummings (2009322) amalgamated two theories to create a theoretical
framework with the premise that employee attendance is based on two factors the ability
to attend and motivation to attend The theoretical framework focuses on individual work
ethics demographics and from the work environment Some form of absenteeism may be
difficult to prove in a situation where the employer has two or more operational stations or
the employee occasionally operates from a virtual office The duty to render service is
breached by the employee when the employee is physically present and mentally absent as
would be the case of sleeping on duty Workplace absenteeism is multi-dimensional such as
changes in the work environment that overburden the coping mechanism As a result of this
approach a multi-dimensional framework of absenteeism clouds the causative factors of
absenteeism (Breetzke 20091 Patrick 200124 Tustin 199452)
19
FIGURE 21 CONCEPTUAL FRAMEWORK MODEL
(Adapted from Davey amp Cummings 2009320)
The conceptual model uses individual predictors of absenteeism such as age salary level
tenure race gender occupation educational level job satisfaction and organisational
commitment ability to attend and pressure to attend Organisational commitment is
described as having loyalty to the organisation identifying with its core values and
influences whether or not an employee feels it is appropriate to take unauthorised
unscheduled absences Group level absenteeism is not viewed as a predictor of individual
absenteeism (Davey amp Cummings 2009320 Lambert Camp Edward amp Saylor 20058-9)
25 PREDICTORS OF ABSENTEEISM
Oi-ling (20023-6) claims that in Hong Kong there were 47500 work days lost as a result of
employee sick leave in 1998 and suggests the examining of stress levels for nurses in
different cultures to enable a fuller understanding of the predictors of absenteeism as
different cultures accept some predictors and some reject the same reasons for illness
20
Personal characteristics
2Employee value Job
expectation
1Job situation scopejob level role
stress work amp group size leadership
style
4 Satisfaction
with job situation
3 Ability to attend Illness and accidents transport problems
6 Attendance motivation
7 Employee
attendance
5 Pressure to attend work
incentiveswork ethics
Education
salary
tenure age
gender race
Occupation
Lambert et al (20058) claim that organisational commitment job satisfaction job stress
health issues and personal characteristics correlate as regards employee absenteeism The
findings of the research by Van Der Westhuizen (2006136) focused on high and low
combination of job involvement and organisational commitment and the outcome was
emphatic on the turnover as predictor of absenteeism
According to Unruh and Strickland (2007674) absenteeism from the workplace contributes
to a vicious cycle of a negative work environment which leads to more absenteeism and
increased turnover McCormick and Ilgen (198556) describe turnover as dysfunctional
where an employee wishes to leave the institution and the employer prefers to retain the
individual and is functional where the employee wishes to leave the institution and the
employer accepts the termination of services by the employee
De Wit (2006) focused on attitudes towards job factors that had an influence on
absenteeism and was not able to find a high coefficient in the test sample McGoldrick and
Arrowsmith (20018) claim that an organisation is healthier for a spread of ages Ferguson et
al (200138) state that aging employees expose organisations to high levels of absenteeism
through higher probabilities of becoming disabled for longer periods
Oi-ling (20023-6) and Patrick (200124) found that gender and age among other predictors
of absenteeism have a significant influence on absenteeism Age was positively related to
well-being in managers and negatively related to absence frequency among hospital
employees Older employees were shown to have higher responsibility at work and utilised
minimal days for sick leave Female employees were observed to have utilised more
absences than males
Andrews (1997221-222) and MINTRAC (20093-8) state that gender moderates the age
turnover relationship Women are more likely to remain in their jobs the older they get than
men do Turnover is occasionally related or preceded by high workplace absenteeism The
occupational category is linked to skill levels and salary levels The lower skill employees are
concentrated in the lower skill occupations and easily replaceable Public service employees
enjoy security of tenure which maybe a contributory cause of absence from work without
good cause a practice that is encouraged by the knowledge that they cannot be easily
dismissed from their jobs therefore have the belief it is right to stay away from work
Rogers and Hertin (1993217-222) found a correlation between the use of sick leave and
age Employees with advanced age comparatively used more sick leave in comparison with
younger employees The level of education seems to have influenced the use of sick leave
where the lower level categories of employees were found to have a higher level of
absenteeism than higher educated individuals
21
Robbins et al (200447) state that married women employees have fewer absences and
undergo fewer job turnovers Rogers and Hertin (1993222) express tenure as work
experience in years that is viewed as a predictor of employee productivity where seniority
has been found to be inversely related to absenteeism in terms of frequency and total
number of work-man days lost The level of education was found to have an influence
where the lower category of employees was found to have higher levels of absenteeism
than higher educated employees Jacobs and Roodt (2011425) and Davey and Cummings
(2009320) state that an organisational culture in hospitals can contribute towards lower
turnover as the turnover rate is a predictor of absenteeism The process can be facilitated
by promoting knowledge sharing that can provide opportunities that may meet employee
expectations
Pousette and Hanse (2002229-231) suggest that theories that make predictions about
antecedents to ill health and sickness absence make the assumption that the relationships
are the same in different occupations Reduced job autonomy is suggested to be associated
with higher sickness absence The occupation specific model is used in order to identify the
variance in the patterns in terms of occupation-groups Davey and Cummings (2009320)
found that turnover was significantly related to absenteeism
Hirschfield et al (2002553) conducted a research on low-wage public sector clerical
employees and found that those employees who perceived limited performance-reward
expectancies were likely to be absent more often The link between skilled employees and
absenteeism suggested that employees may have utilised absenteeism as a means of
compensating for perceived workplace contributions not extrinsically rewarded Unruh et al
(2007674) found that absenteeism from the workplace does contribute to a vicious cycle of
a negative work environment which leads to more absenteeism and increased turnover
26 A MULTI-GROUP INVARIANCE MODEL
A multi-group invariance structural model represents different types of occupations such as
industrial blue-collar workers industrial collar workers elderly care workers and child
health care workers The focus of this model relates to the extent to which a model that is
assumed to include a general population also includes sub-populations such as different
occupational types The occupation specific model allows different relationships between
variables in different occupations The specific model approach allows for identification of
the most common reasons for absenteeism and early retirement in the workplace and was
successfully utilised in Sweden A common model proposes that absenteeism is a
behavioural response to dissatisfaction with the job (Pousette amp Hanse 2002230-244)
Nyathi (200059) found that professional nurses were absent from work because they
wanted to prolong their weekends
22
Davey and Cummings (2009313) argue that on average health care employees are more
likely to be absent from work as a result of illness or injury than other occupations Paton
(20104) acknowledges that line managers are the fundamental building blocks for reducing
absenteeism and must be provided with the tools to manage absence The absence rate at
3 is considered very high and must be vigorously and progressively managed
FIGURE 22 MODEL SPECIFICATION
(Adapted from Pousette amp Hanse 2002232)
Pousette and Hanse (2002232-245) make the assumption that low job autonomy and low
skill discretion deprive the employees of the opportunity to handle work obstacles and
regulate workload to a manageable level implying a negative relationship to workload has
an impact on absenteeism rate Patrick (200123-24) states that changes in the working
conditions overburden the coping mechanism Work-related stress can lead to deteriorating
physical and emotional well-being The work object is the distinguishing quality between
occupations in the different occupational groups whereby the blue-collar employee works
with things that are tangible such as materials and machines whereas the white-collar
employee is knowledge based employee who is working with data
23
Structural Model
W L Work load
I H Ill-Health
S A Sickness absenteeism
S D Skills discretion
(autonomy)
27 CATASTROPHIC MODEL (CAT)
According to Buschak Craven and Ledman (199628) the catastrophic model (CAT) caters for
major illness that keeps the employee away from work for extended periods of time This
model is similar to short and long term incapacity sick leave whereby the employee has
exhausted the normal sick leave of 36 days which is catered for by DPSA section 14 (RSA
2009)
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM
The general behaviour and actions of public officials are determined by specific ethical
codes of conduct and the unethical conduct results in effective administration and
unsatisfactory service delivery (Andrews 199733) Effective control of workplace
absenteeism requires an absenteeism policy to be in place management to establish the
magnitude and patterns of absenteeism and raise awareness about the consequences of
breaking these rules (Bamford Klein amp Engelbrecht 19992)
The Determination on Leave of Absence in the Public Service (DPSA 2009 section 14 141)
the Public Service Co-ordinating Bargaining Council Resolution (PSCBC 72000) Davey and
Cummings (2009313) and DPSA (PILIR) 2009 section 3 31 state that an employee is
entitled to 36 working days sick leave with full pay in a three year cycle with the same
employer Any unused leave credits shall lapse at the end of the three year cycle The
employee is expected to utilise and manage the normal leave circumspectly The employee
who chooses to utilise sick leave days must submit a medical certificate for every occasion
of three or more sick leave days utilised The medical certificate must be issued and signed
by a practitioner or persons who are registered with the Professional Councils established
by the Act of Parliament Incapacity leave is additional sick leave granted conditionally at the
employerrsquos discretion An employee who has exhausted the normal sick leave during the
prescribed sick leave cycle and who requires to be absent from work due to a temporary
incapacity may apply for temporary incapacity leave with full pay According to the Policy
and Procedures on Incapacity Leave for Ill-Health Retirement (PILIR) (DPSA 2009) an
employer is not required to pay an employee if the employee has been absent from work
for more than two consecutive days or more than two occasions during an eight week
period and on request does not produce a medical certificate
The Public Service Regulations 2001 F (c) holds the manager accountable when an
employee abuses sick leave (RSA 2001) According to Parbhoo (20036) and Nel et al
(2008145) the doctor patient confidentiality is not above reach to the employment
relationship by suggesting that the employer can question the authenticity or contents of
the medical certificate if there is sufficient reason to do so within the confines of
confidentiality
24
According to Breetzke (20092) South African employees are challenged by global trends to
seek mechanisms to deal with excessive absenteeism at the workplace The Charted
Institute of Personnel and Development (CIPD) (200811) claims that the 2006 survey
showed that public sector employees are less likely to be disciplined or dismissed for
reasons of workplace absenteeism
281 Measuring absenteeism
Measuring absenteeism in the workplace enables the employer to determine the extent and
nature of the problem Absenteeism is measured using two measures total time lost and
absence frequency Nel et al (2001584) In institutions total time lost is determined for
every group of employees and category of absence such as sick absence authorised and
unauthorised absence The recognised international norm is 3 Institutions challenged
whether to accept the international norm as the given or strive to bring workplace
absenteeism down in the interest of quality and quantity of service delivery The total time
lost index is calculated as the Total number of days lost due to absence over the period
multiplied by a thousand and divided by the average number of employees multiplied by a
thousand and divided by an average number of employees multiplied by total work-days
over the period (Amin Das amp Goldstein 20086 Breetzke 20094 Nel et al (2001584)
According to Nel et al (2001584) high workplace absenteeism rate is suggestive of incidence
that is of short duration and therefore more disruptive to the operational plans of an
institution as prior knowledge of pending workplace absenteeism allows for forward
planning and reduction of the costs associated with absenteeism The absence frequency
rate is calculated as Number of absence incidence over the period divided by the average
number of employees employed over the period (Breetzke 20094 Nel et al 2001254)
29 IMPACT OF WORKPLACE ABSENTEEISM
Lambert et al (20056 36) claim that absenteeism has adverse effects on those employees
who are good attenders as they are shuffled around to fill in the positions of absent
employees Organisations suffer the detrimental effects and consequences of employee
absenteeism Management expend valuable time to modify employee assignments to
respond to absences When employees who are in management or in highly specialised job
assignments report sick the work assigned to them remains undone because their positions
remain vacated and the work remains for them to complete The responsibility and
accountability these employees are entrusted with may influence less use of sick leave by
them
The White Paper on Transforming Public Service Delivery (DPSA 1997) holds management
responsible for the specific level of resources and for obtaining value for money in these
resources
25
Madibana (201022) found in the research about absenteeism amongst nurses that the high
rate of absence had an impact in the reduction of quality care rendered by nurses
291 Cost to the institution
Andrews (19978221) describes an institution as the process through which activities are
grouped logically into the distinct areas and assigned to managers It results in the logical
grouping of activities in a department Workplace absenteeism influences the cost of an
institution which influences the quality of the product or service that is rendered by the
institution Employee attendance is a vital element for managing productivity of any
institution and its individual members The unfilled posts reflect the absence of public
health care employees and do not absorb budget resources for salary and upkeep of
facilities Absent personnel still receive their salaries If public servants are not on the job
the expenditures embodied in them do not reach their beneficiaries (Chaudhury amp Hammer
20032 Lambert et al 20055) The cost is direct in terms of salary expenditure or indirect in
terms of staff replacement
Ferguson et al (200138) argue that the cost of employment risk approach is about
estimation of the possible cost of any absent employee to an institution per hour per day
Robbins Odendaal and Roodt (200415) estimate that absenteeism costs South African
institutions millions of rand a year in decreased efficiency and increased benefit payments
Fakie (20053) notes that sick leave costs the national government 15 of the total basic
salary expenditure for the National Department of Health from 1 January 2001 to December
31 2003
The South African Chamber of Business (SACOB) (Patrick 200117) acknowledges that in
2006 about R19 billion were lost on account of absenteeism resulting from sick leave
According to the European Foundation (19977) United Kingdom lost 11 billion pounds in
1994 Germany lost 30 5 billion EUC in 1993 and Belgium lost 24 billion EUC in 1995
Breetzke (20092) describes indirect costs as hidden costs harder to measure and may
include economic value of lost productivity Indirect costs relate to loss of production that
may arise by engaging some expects to provide service in the field where they are closing
the staff shortage gap Rogers and Hertin (19939) and the European Foundation (19978)
view the individual employee and his or her dependants in a social dimension aspect as
exposed to reduced income as a result of extended workplace absenteeism related to ill
health where long term incapacity is involved
The total cost of employment risk approach is about estimation of the possible cost of any
absent employee to an institution per hour The cost may be direct and indirect such as
overtime low productivity and a decline in morale among workers who are expected to
cover for an absent employee (Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
26
292 Low productivity
According to Jankowitz (19911) high levels of absenteeism are disruptive to production
where operators are interdependent or where levels of service have to be maintained
Buschak Craven and Ledman (199626) argue that absenteeism generates costs for the
institution and productivity problems put an unreasonable burden on the rest of the
employees who are at work An absent employee be it physical or psychological remains an
unproductive employee Absenteeism viewed from an employerrsquos perspective is regarded as
a problem that impacts negatively on service delivery while the employeesrsquo believe their
mere presence in the workplace is being productive
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM
Managing workplace absenteeism remains a challenge for all employers and the Gauteng
Department of Health has not been spared the challenges faced by other institutions as it
provides health care services to the citizens of Gauteng The provision of good quality health
care is vital for the development of human capital The implications of declining quantity
and quality of care is grave when the human capital equity and efficiency which are the
cornerstones of health care service delivery are threatened by employees who are not at
work when expected to be (Gauteng Province 200711) Misuse of sick leave is considered to
be an overriding problem in instances where the employee does not uphold the standard of
honesty and incorruptibility or these values are not considered to be the corporate values of
the institution (Andrews 1997 221-222 MINTRAC 20093)
According to Grogan (2005237) employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
identify trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
Part V Section F(c) (RSA 2001) The workplace can be a virtual office Workplace
absenteeism is perceived to be high in unionised workplace environments where unions are
perceived to be capable of exerting control over the employer and employee relations for
the primary benefit of the employees In the public sector contractual employee benefits
are modified by collective agreements
Public service managers are to focus towards results achievement and be accountable for
the performance of their institutions (Gauteng Province 201023) Workplace absenteeism
can be reduced by tightening up policies and procedures relating to control of absenteeism
and intensifying monitoring processes on absent employees
27
According to Cloete (2004290-297) public institutions are to provide quality goods and
services The public institutions require an appropriate infrastructure to enable them to
perform their core functions (Bamford et al 19991 Buschak et al 1996 28 Munro
200722)
2101 Effective communication
According to Oi-ling (200212) managers should alter the psycho-social environment at work
and cultivate an institutional climate that supports staff and facilitate effective
communication Institutions should raise awareness to employees of their rights and
responsibilities regarding leave of absence and the consequences of abusing it (Bamford et
al 19992) The policies should be clearly written and well communicated to all employees
and be readily available and accessible In a highly unionised environment these policies are
debated in bilateral or multi-lateral forums between management or employer
representatives and labour representatives The human resource practitioners must conduct
periodic in-house training on these policies for management and employees to facilitate
uniform interpretation and enforce compliance by all stakeholders The policies must be
couched in simple understandable language that is free of legal terms for ease of
comprehension by all users The policies on workplace absenteeism must be explicit of
actions to be taken when policies have been violated or employees are aggrieved
2102 Empowerment of managers
Workplace absenteeism is multi-dimensional requiring inputs from all related fields
Managers require on-going support and training on issues that relate to absenteeism at the
workplace The human resource unit works with managers to establish performance
standards training of employees on the importance of execution and assists managers to
focus on continuous improvements superior execution and employee empowerment
(Bergdahl 20019 RSA 2011)
The labour relations unit supports the training of managers on grievance handling bilateral
and multi-lateral encounters with employee representatives with employee education
issues specific to workplace absenteeism The Charted Institute of Personnel and
Development (CIPD) (200835) reported that 70 of managers in the public service have
been trained in workplace absenteeism handling
Employment relationships bind human resource and industrial relations together with the
common objective of achieving institutional goals and labour peace Managers focus on
managing the institution for productivity at the lowest possible cost by providing quality
care therefore reducing the risk of litigation control of absence from work and work
efficiency
28
It is the delays in dealing with issues that give the employees the feeling of being unfairly
treated and demoralised Consistency in upholding these processes is essential for creation
of a stable employment relationship while any deviation from the set processes give rise to
worker unfriendly environment (Bergdahl 20118-9)
2103 Monitoring of workplace absenteeism
The manager is expected to keep accurate records for all leave of absence taken by
employees In terms of the management of ill-health absencersquos the manager has to ensure
that the eight week rule is observed whereby the employee who has been absent from
work on more than two occasions during an eight- week period must regardless of the
duration of the sickness or injury submit a medical certificate (RSA Part V section F (b)
DPSA 2009 section 14 148) Pierce (200921) believes that management of human capital
may be achieved through the integration of employee benefits employee assistance
programmes and human capital
Monitoring of absenteeism is a human resource function that gets lost in the competing
functions that are carried out by human resource practitioners High levels of absenteeism
are an indication of poor management and or conflict within the employment relationship
The methods to monitor workplace absenteeism vary from one institution to the other It is
human resource management that establishes common guidelines that are used by
management to monitor workplace absenteeism In monitoring absenteeism the manager
considers each employeersquos case on its merit
The manager focuses on certain aspects of the case such as failure to call in on the day of
absence pattern of use of sick leave before or after holidays and sick absence occurring on
certain days of the week or month Monitoring systems to monitor and record attendance
of work are put in place to assist management with simple accurate functional data that
facilitates informed decision- taking at management level The employees of the province
and their attendance at work become the focal point of the province in relation to service
delivery Peer pressure monitoring comes from colleagues at the same facility Hierarchical
monitoring of employees by management may lead to more attendance for fear of being
discovered (Chaudhury amp Hammer 200319 Gauteng Province 201015) A health care
service institution may use Health Information System and Personnel and Salary
Administration System (PERSAL) among others to ease the burden of the monitoring
process All these tools combined are useful in gathering administrative data for
management
29
2104 Visits to facilities
The role of human resource at institutional level is to support and guide management as
well as monitor compliance issues Workplace absenteeism remains a key focus area
because of its impact on the budget of an organisation Unscheduled facility visits are
conducted with the view to audit workplace absenteeism The audit is to be done in line
with the auditor-general or internal risk managementrsquos approach to encourage consistency
A check list that is used is prepared by human resource practitioners and institutions are
familiar with A human resource accounting officer of the institution should be involved
when an audit is done
The institution must have evidence available of sporadic visits to employees who have been
identified as having developed absenteeism patterns with the view to rule out elective
absence The European Foundation (199713) and Munro (200722) state that ill- health is
the main reason for workplace absenteeism Employees who present with ill- health are
generally and frequently more absent from work than the healthy ones The authors also
observe that not all employee assistance programmes aimed at reducing workplace
absenteeism have an effect on the ill-health of the employees which render the
unscheduled visit to the employees vital to see where the caring employer could be of
assistance
2105 Incentive system
According to Buschak et al (199628) the catastrophic model (CAT) caters for major illness
that keeps the employee away from work for extended periods of time This model is similar
to short and long term incapacity sick leave which is catered for by PILIR subsection 73
(DPSA 2009) The managers require special training for successful implementation of the
policy The paid time off model (PTO) has hidden benefits incentives for employees not to
use unnecessary sick days which are then paid for at retirement The research by Lambert
and Camp (20054) compares the Civil Service Retirement System (CSRS) and the Federal
Employees Retirement System (FERS) and showed that in the final analysis and when
novelty wore off workplace absenteeism was not necessarily reduced by the incentive
system
Management should use the strategy to raise awareness about responsible utilisation of sick
leave through workshops about PILIR and the eight week rule It should show the benefits
of good sick leave management when employees are challenged with temporary or
permanent incapacity leave
The use it or lose it approach of the current system reward the abuse of sick leave as it is
viewed as not being beneficial by the employees to act responsible towards the use of sick
leave There is no deterrent not to abuse sick leave in the public sector
30
2106 Team support
Institutions value team effort over individual achievement Operational competencies are
viewed as essential Managers encourage effective communication among team members
motivating others and the development of problem-solving skills Managers through the
team development effort encourage nurturing and transmitting of the institutional culture
Institutional culture refers to a system of shared meaning within an organisation that
determines how employees behave in the workplace Culture and people are like glue that
ensures that institutional standards are upheld Individuals become units that form the
team and conversations at work are encouraged to strengthen team work knowledge
transfer and productivity (Bergdahl 20018-10 Goldsmith amp Morgan 200378 Robbins amp
Decenzo 2001174)
2107 Return-to-work interviews
According to Paton (20101ndash5) a phased return-to-work data management and remote
services are among the approaches employers may use to manage workplace absenteeism
The intervention can involve use of Information Technology systems and telephone
discussions Good absence management is about good people management The return-to-
work interviews provide management with the opportunity to get to know the employee
better and for the employee to substantiate his or her case The employee is afforded
privacy during the sessions which should happen as soon as the employee comes back to
work The key success in this strategy is unthreatening follow ups that are done A multi-
faceted approach is used to get people back to work such as phoning maintaining regular
contact and taking medical advice
The Charted Institute of Personnel Development Annual Report (200835) reported 90 of
public services that use the strategy and 77 use the risk assessment to aid return- to-
work The manager should have private counselling sessions with the employee as soon as
the employee returns to work These sessions provide the employee with the opportunity to
put his or her case across and for the employer to get a first-hand opportunity to asses if the
employee is fit enough to come back to work The employer has to make the employee
aware of the status of the meeting that it is formal and proceedings are recorded The
employer is to keep accurate records of all counselling sessions
31
2108 Employee assistance programme (EAP)
DPSA (PILIR2009) prescribes that the PILIR committee promotes EAP in the workplace and
each institution to establish a committee The PILIR committee consists of a labour relations
officer an EAP practitioner a health practitioner an employee wellness practitioner and
any other relevant practitioner who is co-opted on a needs basis The purpose of the
committee is to manage short and long term incapacity which is sick leave utilised after the
employee has exhausted the 36 days normal sick leave in a three year cycle The short term
incapacity sick leave is of longer than three days and less than 29 days and long term
incapacity is sick leave longer than 29 days The short spells of sick leave become a concern
when there is evidence of a pattern of abuse It is a call for the manager to intervene Every
organisation should provide EAP that is funded by the employer to the employees A health
risk manager is used by the employees who are expected to honour referrals and stay with
the programme until such time that there is evidence of recovery failure by the employee
to accept the programme should attract a disciplinary process
According to Mellor Arnold and Gelade (20098) the amount of support that followers
receive from their transformational leader or co-worker may help reduce levels of absence
by making the workplace a more pleasant place to be and perhaps by helping the person
find solutions to work out family conflict or other problems that produce absence Landstad
et al (20011) suggest that the individuals in the preventive intervention group who were
less than 42 years of age total absence due to sickness decreased The change was obvious
to the cleaners who had a previous history of high absence due to sickness The Charted
Institute of Personnel Development (200836) focused on working-man days lost
management of absenteeism employee well-being and employee rehabilitation The skilled
employees were reported as 12 who were using rehabilitation programmes Yende
(200535) and Fakie (200517) state that EAP despite having been around since 1996 for the
National Department of Health has not actually been managed and utilised to its full extent
whereby if fully utilised would assist in the management of employee workplace
absenteeism
2109 Occupational and safety committee
The focus of this committee is on the provision of a safe working environment by the
employer (RSA Part VI section D 2001) It monitors issues of compliance and adopts the
employee advocacy role The committee consists of all the major stakeholders such as
employee representatives labour representatives that represent employees in the
institution on issues of safety at the workplace In the context of the Gauteng Department
of Health the committee engages with the labour representatives and employer
representatives at bilateral and provincial multi-lateral scheduled meetings
32
According to Du Toit and Van Der Waldt (1998139) the International Labour Organisation
recommends creation and maintaining of a pleasant work environment in order to improve
productivity The environment must stimulate the employee to ensure efficiency and
effectiveness
21010 Review committee
This structure is essential when dealing with incapacity leave It is composed of
management human resource practitioner employee representative labour relations
officer employee wellness and any adhoc person needed in terms of the case under
discussion (DPSA PILIR 2009) The employee reserves the right to lodge a grievance about
the outcome of his incapacity request if it is negative The role of the committee is to
provide a transparent forum reduce hostility against management and to protect the rights
of the employee through involvement of the employee representative
211 CONCLUSION
The literature review that has been consulted explores the workplace absenteeism and its
impact on the institution The employment relationships represent a triangle that consists of
the employer the employee and the industrial environment The relationship is multi-
dimensional and highly regulated with built in mechanisms to handle conflict in the
workplace Conflict is inherent to the employment relationship and structures and
mechanisms such as bargaining councils the Commission for Conciliation Mediation and
Arbitration and Labour Courts are structures for recourse The theory of absenteeism and
employment relationship were explored Management intervention strategies were
explained Controlling absenteeism in the workplace begins with a sound absenteeism
policy that is incorporated into an employee induction programme Communicating and
educating the employees about the absenteeism policy takes the centre stage in the
employment relationship Vigilant monitoring of workplace absenteeism is the responsibility
of the manager closest to the employee such as the supervisor Workplace attendance
problems of employees can be handled using sound judgement keeping accurate
attendance records and administering the policy fairly and consistently
Chapter 3 will collect data which will confirm or negate the literature review that has been
explored in chapter 2
33
CHAPTER 3
METHODOLOGY OF THE RESEARCH
31 INTRODUCTION
Chapter 3 focuses on the methodology used to determine the absenteeism in the four
hospitals of the Gauteng Department of Health The research design and the methodology
that have been used to collect data are discussed below The data are collected in terms of
the characteristics of the stratified random sample such as absenteeism of the different
occupational categories gender age tenure of service race groups and salary
32 RESEARCH DESIGN
A research design is the overall plan for relating the conceptual problem to relevant
empirical research It is a quantitative descriptive research that involves the systematic
collection of numerical information under conditions of considerable control The choice of
the research design influences subsequent research activities such as identifying the target
subjects what data to collect and how they should be collected The research design is a
descriptive survey which is concerned with characteristics of a specific population subject at
a fixed point in time for comparative purposes The focus is on a representative sample of
the relevant population It is concerned with the accuracy of the findings and their
generalisability The survey is used to understand the behaviour of employees with regards
to motivation satisfaction and grievances (Babbie 1992 89 Ghauri et al 199527 60 Brink
199611 Welman et al 200152)
321 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services The four hospitals that have been targeted for the study of absenteeism are Tara
Moross Centre Hospital in Region A under the Johannesburg Metropolitan Municipality
Germiston Regional Hospital which is in Region B under Ekurhuleni Metropolitan
Municipality ODI District Hospital in Region C under Tshwane Metropolitan Municipality
and George Mukhari Academic Hospital in Region C under Tshwane Metropolitan
Municipality Each hospital is unique in its character in terms of specialisation of health care
delivery service The sample is a stratified random sampling which is composed of various
clearly recognisable non-overlapping sub-populations (strata) that differ from one another
in terms of variables that are a combination of more than one variable such as age sex
income level or educational level The purpose is to ensure that every part of the population
(every stratum) is represented The members of a particular stratum are homogeneous with
the population at large
34
The sample is representative of a population with clearly distinguishable strata with a
greater degree of certainty (Babbie 19927 Brink 1996138 Brynard amp Hanekom 2005 44
Ghauri et al 199578 Welman amp Kruger 200155-56 Polit amp Hungler 199518)
The data were collected in three phases The first phase of data collection was done through
auditing of hard copies of identified personnel files encomprising ten files per hospital and
using the tools in annexure A and B The forty employeesrsquo profiles were accessed through
the Human Resource Information System (HRIM) located in the Gauteng Department of
Health Head Office The respective employeesrsquo profiles were handed over to the human
resource manager in the respective hospital on the morning of the audit for the human
resource practitioner to draw out the hard copy files for auditing The characteristics of the
individuals that were identified for the first phase were males and females as well as
representatives from the different race groups The auditing of the files were for the
complete working life of the employees and not only confined to 2008 calendar year
Registers that are used by human resource administration to control the movement of the
leave form were inspected as evidence of the control system in place The purpose of
auditing the files was to gain insight into how leave in general was captured managed and
controlled by the hospitals
The second phase of data collection were done through structured interviews with four
human resource managers who were directly accountable for management and control of
leave of absence in general in the four hospitals A structured interview provides for a more
organised approach and a more stable basis for assessment of the different candidates
(Erasmus et al 2005250) The structured interview was conducted using the tool in
annexure C Tara Moross Centre Hospital had been functioning without a human resource
manager and the manager that was interviewed had been in the post for three months The
human resource practitioner who was at salary level 8 and acting in the Assistant Directorrsquos
post (manager level 9) was invited to join the manager and be part of the structured
interview ODI District Hospital had three human resource practitioners including the
accounting officer at level 8 in an acting capacity The third phase of data collection was
through the Human Resource Information Management System (HRIM) This system uses
the Personnel Remuneration Administration System (PERSAL) to collect data Data in this
system is categorised in characteristics such as salary level date of appointment
occupational category gender age in units of five race employing hospital employment
status in different sub-categories such as session contract and full-time and the different
types of leave of absence The continuous sick leave of four to five days was excluded from
processing and focus was laid on sporadic days to the start and end of a weekend
35
The research used secondary data in analysing sick leave utilised by full time employees in
the identified hospitals for the period of 1 January to 31 December of 2008 using Persal The
total population sample was four thousand and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range from level 1 to
12 The research used past events such as sick leave utilised by employees using secondary
data from Persal falling into the category of historical empirical study The interval scale of
measurement was used in the quantitative research and actual numbers are ordered with
equal measurement between each category (Brink 1996 149 Brynard amp Hanekom 200528-
29 Mouton 200552100170)
33 UNIT OF ANALYSIS
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the study refers to observation of work attendance by the
employees of Gauteng Department of Health in the four hospitals The observation deals
with the historical events as employees have already utilised the sick leave in the workplace
The subjects that are studied are the core health care providers such as doctors nurses and
support employees such as allied administration and administration support (Mouton 2005
51-52 Welman et al 2001 52-53)
34 UNIT OF OBSERVATIONS
The observations that are made are of health care employees and support teams in Tara
Moross Centre Hospital Germiston Hospital ODI Hospital and George Mukhari Hospital
and describe the characteristics of a large number of individual people such as sex age
salary range occupational category tenure of service and race in relation to absenteeism in
the workplace The descriptive study and the individual characteristics are aggregated for
the purpose of describing a larger group (Babbie 199292)
35 CONSTRUCT VALIDITY
Construct validity is concerned with the question What construct is the instrument actually
measuring (Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with four of the accounting officers in the leave managements The third phase was
collecting of personnel data through the Persal system
36
36 ETHICAL CONSIDERATIONS
Ethical considerations will include amongst other issues such as the protection of the units
of analysis and units of observations from discomfort and harm by not revealing
information which can cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity
Anonymity is achieved when the researcher cannot link a given response with a given
respondent and reporting aggregate data only When data are collected at one sitting and
not over a period of time makes it possible to achieve anonymity as the need for follow up is
eliminated Subjects of observations are selected for reasons directly related to the problem
being studied as the principle of justice Confidentiality is about the researcherrsquos
responsibility to protect all data gathered within the scope of the study and shared only
with people involved in the research (Babbie 1992465ndash466 Brink 199640ndash41 45 Polit amp
Hungler 1995 31-36)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous to the researcher The interview was part
of the actual audit that was done as part of monitoring and evaluation that was in progress
in the Department of Health following a negative auditor generalrsquos report about
management of leave in general The managers were put at ease as they were given the
checklist afterwards for self-monitoring and for future self-auditing
The data that were collected through Persal identified employees through the Persal
number and kept their identities anonymous The data that were collected through the hard
copy of employeesrsquo files were used to point out areas of concern to the managers and the
files did not leave the office of the manager at the end of the process once more protecting
the identity of the employee
37 CONCLUSION
This chapter dealt with the research design which is the overall plan for relating the
conceptual problem to relevant empirical research The methodology used a stratified
random sample which is composed of various clearly recognisable non-overlapping sub-
populations that differ from one another in terms of variables that are a combination of
more than one variable The data collection was done through three phases The unit of
analysis refers to the persons who are studied The unit of observations are health care
workers and support teams in the four identified hospitals The construct validity used a
multi-trait multi-method approach Ethical considerations include among other issues
protection of the unit of analysis and the unit of observations from discomfort and harm
Chapter 4 discusses the analysis and interpretation of the data gathered in chapter 3
37
CHAPTER 4
INTERPRETATION AND ANALYSIS OF DATA
41 INTRODUCTION
This chapter focuses on the research analysis and interpretation of data gathered on
workplace absenteeism in the Department of Health of the Gauteng Province It seeks to
identify differences or similarities in the leave trends in the 2008 calendar year between the
four identified hospitals chosen for the study in the Municipality of Tshwane Ekurhuleni and
Johannesburg The year 2008 was chosen as a second year in the leave cycle that started in
2007 The type of leave of absence is interpreted as a collective that does not specify the
type of sickness or illness or it being acute or chronic Workplace absenteeism is absence of
the employee at the workplace that is defined by Du Toit and Van Der Waldt (1998139) as
the place that the institution makes available and where officials have to perform their
work It forms part of the internal environment for public administration in the public
service Direct public administration is directly concerned with the rendering of services to
the citizens of the country
Chapter 4 discusses the study of workplace absenteeism in the four identified institutions
namely Tara Moross Centre Hospital Germiston Hospital ODI District Hospital and George
Mukhari Hospital In this research the following factors will be examined the organisational
structure and absenteeism of the different workforce categories such as medical and
nursing professionals administrative staff allied professionals and various categories of the
general assistants workforce and their relation to absenteeism in the institution
42 THE STRUCTURE OF THE ORGANISATION
The Gauteng Province is one of the nine provinces of South Africa In 2005 the auditor-
general conducted an audit of sick leave performance in six national departments and the
Gauteng Province was among those that were omitted from the audit The research focuses
on the Gauteng Department of Health (GDoH) whose core function is to provide health care
services to the people of Gauteng The provision of health care services is labour intensive
and requires large numbers of personnel for effective service delivery The GDoH is serviced
by thirty-four hospitals four of which have been identified for the study of management of
sick leave The employee attendance to work is essential to the achievements of the
Departmental goals The Determination on Leave of Absence determines the leave policy for
public service employees (DPSA 2009) The employees of GDoH represent the staff
component as reflected in the organisational structure of the department
38
The Gauteng Department of Health (GDoH) provides the basic health services to the people
of Gauteng who as internal or out-patients are clients or consumers of the services referred
to as line functions Public administration services rely heavily on support services such as
the personnel department that renders support to line functions that provide the actual
service of patient care Support services are considered as indirect public administration
services and essential in efficient public service delivery Workplace absenteeism has a
negative impact on productivity Employees of the Gauteng Department of Health and their
attendance to work are the focal point of the Province in terms of effective health care
service delivery that is customer focused
Political ideologies as those espoused by labour representatives are part of the external
factors in the workplace environment that consequently have an impact on public
administration and management and workplace attendance by employees (Du Toit amp Van
Der Waldt 1998139170)
FIGURE 41 INTERGRATED ORGANISATIONAL STRUCTURE
(Adapted from Gauteng Department of Health organisational structure 2010)
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY
The Gauteng Provincial Government has made a commitment to its people to account for
the delivery of services as its electoral mandate This commitment will be achieved only
when monitoring and evaluation of its performance is enforced by all Gauteng Department
of Health service providers
39
MEC
HOD
COP
Senior Exec
CD HAST CD Health program
Senior Exc
CD Tshwane
CD JHBWest
CFO
Manage Account
SENIOR CORPORATE
HRM amp LR
GenderampDisability
The Gauteng Governmentrsquos commitment to provision of health care services to all its
citizens is demonstrated by the decentralisation of management of service delivery with the
view to foster accountability increase efficiency and accountability (ANC 199419ndash20
Goldstein 200815) The interpretation of the analysed data takes the sector performance
approach into consideration when the interpretation of absence is across all the
occupational groups for the 2008 calendar year (Gauteng Province 201015)
44 COMPARISON OF HOSPITALSPERMANENT EMPLOYEES
Gauteng employees are counted at 51475 from the Personnel Salary Administration System
(PERSAL) as of March 2008 The population from the four chosen hospitals has been
counted at 4010 reflecting 8 of the total population The different groups of employees
were identified as Africans represented as n=3902 Whites as n=51 Indians as n=14 and
Coloureds as n=43
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALS
(Source Compiled by the researcher C S Ndhlovu 2012)
Figure 42 reflects the racial split percentage of the workforce (n=4010) of the hospitals
The population from the four hospitals has been counted as 4010 reflecting 8 (n=51475)
of the total working population for Gauteng Department of Health as from 1 January to 31
December 2008 The different groups of employees were identified as Africans represented
by 973 (n=3902) Whites as 13 (n=51) Indians as 03 (n=14) and Coloureds as 11
(n=43) The George Mukhari Hospital has a female dominated workforce at 739 (n= 2097)
in a total workforce of n=2836
40
Population n=4010
Africans 973
Whites 13
Coloureds 11
Indians 03
TABLE 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALS
RACE TARA HOSPITAL GERMISTON GEORGE
MUKHARI
ODI TOTAL
Africans 227 367 2836 472 3902
Whites 23 24 3 1 51
Coloureds 5 37 0 1 43
Indians 13 1 0 0 14
Population 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 1 focuses on the distribution of race and the population of the total workforce The
geographical area of the hospital determines the demographics and the tendency of some
groups being poorly represented or totally absent The research focused on permanent
employees of the four hospitals The George Mukhari Hospital employees are reflected as
7079 (n=2839) ODI Hospital as 1182 (n=474) Germiston Hospital as 1069 (n=429)
and Tara Moross Centre Hospital as 668 (n=268) of the total working population Tara
Moross Centre and Germiston Hospitals are located in cosmopolitan areas while the George
Mukhari and the ODI Hospitals are in rural and semirural areas The positioning of the latter
hospitals may account for the high African workforce
41
TABLE 2 COMPARISONS OF NUMBERS OF ADMINISTRATION AND SUPPORT STAFF IN THE
DIFFERENT HOSPITALS
OCCUPATIONAL
GROUP
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Administration
staff
48 60 297 61 466
Administration
support
103 140 719 133 1095
TOTAL 151 200 1016 194 1561
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 2 presents the administration employees and the administration support in the four
hospitals Tara Moross Centre Hospital is represented by 3179 (n=151) of administration
and 6822 (n=103) administration support The George Mukhari Hospital has the highest
representation by the administration support at 7077 (n=1016) The high representation
of the administration support staff at George Mukhari Hospital could be partly because of
the semi-rural environment A semi-rural environment is usually characterised by poverty
which may have a negative influence on opportunities to access education and skills
Doctors and nurses are highly marketable because of the educational levels and skills that
are lucrative and enable this group to be highly mobile geographically (Chaudhury amp
Hammer 20033)
42
TABLE 3 GENDER COMPARISON IN DIFFERENT HOSPITALS
GROUPS HOSPITALS MALE FEMALE POPULATION
Africans Tara 83 144 227
Germiston 52 315 367
George Mukhari 739 2097 2836
ODI 109 363 472
TOTAL 983 2919 3902
Whites Tara 5 18 23
Germiston 5 19 24
George Mukhari 3 0 3
ODI 1 0 1
TOTAL 14 37 51
Indians Tara 1 12 13
Germiston 0 1 1
George Mukhari 0 0 0
ODI 0 0 0
TOTAL 1 13 14
Coloureds Tara 1 4 5
Germiston 6 31 37
George Mukhari 0 0 0
ODI 1 0 1
TOTAL
GRAND TOTAL
8
1006
35
3004
43
4010
(Source Compiled by C S Ndhlovu 2012)
Table 3 focuses on gender distribution in the population of the research represented by
males and females in the different racial groups
43
The geographical area of the hospital determines the demographics and the tendency of
some groups being poorly represented or totally absent The males of the different hospitals
account for 251 (n=1006) while the females account for 749 (n=3004)
The George Mukhari Hospital has a female dominated workforce at 7394 (n=2097) out of
a total workforce of n=2836 White male employees are represented by 011 (n=3) against
the total workforce of the hospital (n=2839) There are no Indians and nor any Coloured
employees African males are represented by 2603 (n=739) The same hospital has no
white female employees no Indians no Coloureds and 7395 (n=2097) African females
The table reflects a predominantly African female workforce The hospital is situated in a
rural setting and this may have an impact on the vast difference in the gender
representation
The Tara Moross Centre and Germiston Hospitals are located in cosmopolitan areas They
have 187 (n=5) and 1117 (n=5) White male employees respectively and 672 (n=18)
and 443 (n=19) female employees respectively Tara Moross Centre Hospital has 4 48
(n=12) female Indian employees while Germiston Hospital has only 024 (n=1) Germiston
Hospital has 723 (n=31) female Coloured employees while Tara Moross Centre has 150
(n=4) The core function of the various hospitals may have influenced the gender
distribution
TABLE 4 COMPARISON OF TENURE OF SERVICE IN RELATION TO ABSENTEEISM IN THE
FOUR HOSPITALS
TENURE IN YEARS DAYS OF ABSENCE PERCENTAGE
1ndash10 4451 30
11ndash20 6577 443
21ndash30 2934 198
31ndash40 878 59
TOTAL 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 4 reflects the level of tenure of the total workforce from 1 year to 40 years of service
Tenure of 11 years to 20 years of service reflects 443 (n=6577) utilisation of leave of
absence and remains the highest rate of absenteeism followed by tenure of 1 to 10 years of
service at a 30 absenteeism rate
44
TABLE 5 COMPARISON OF THE OCCUPATIONAL GROUPS IN THE DIFFERENT HOSPITALS
OCCUPATIONAL
CATEGORIES
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Doctors 12 12 354 19 397
Professional
nurse
47 81 548 109 785
Staff nurse 15 53 358 56 482
Nurse assistant 16 50 308 55 429
Social worker 4 4 8 3 19
Occupational
therapists
4 0 15 1 20
Radiographer 0 3 27 6 36
Clinical
Psychologists
4 0 10 2 16
Physiotherapists 0 1 9 1 11
Dieticians 0 0 5 3 8
Finance 4 11 59 9 83
Speech
therapists
0 0 5 1 6
Pharmacists 2 9 36 5 52
Dentists 0 0 0 3 3
Technicians 2 5 51 6 64
Librarian 1 0 0 0 1
Security 6 0 30 1 37
Administration
and support
151 200 1016 194 1561
TOTAL 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 5 reflects a great difference in terms of number of occupational groups in the four
hospitals
45
The core function and the size of the hospital seems to have a bearing on how many
occupational categories of employees are to be found in that hospital as well as the actual
figures of these categories The George Mukhari Hospital is an academic hospital that trains
medical doctors This hospital has 1247 (n=354) doctors in a staff establishment of
n=2839 Tara Moross Centre has 448 (n=12) in a staff establishment of n=268 Germiston
has 280 (n=12) in a staff establishment of n=429 and ODI District hospital has 401
(n=19) in a staff establishment of n=474 This trend of vast differences in figures
represented by the occupational groups is evident in the category of professional nurses
where George Mukhari Hospital reflects 1931 (n= 548) nurses Tara Moross Centre is
represented by 1754 (n=47) Germiston by 1889 (n=81) and ODI District hospital by
23 (n=109) The impact of absenteeism is pronounced when viewed against the level of
facility capacity in terms of human resources of the core occupational groups
441 The Tara Moross Centre Hospital
Tara Moross Centre Hospital is a speciality psychiatric hospital in Region A with a workforce
of 669 (n=268) of the total workforce (n=4010) The core function of the hospital is
specialised such that some occupational categories are not available in the hospital as part
of the workforce and patients are referred out to other facilities for specialised treatment
Tara Moross Centre Hospital falls under the jurisdiction of the Johannesburg Metropolitan
Municipality
442 The Germiston Hospital
Germiston Hospital is a regional general hospital in Region B with a total permanent staff
establishment of 1070 (n= 429) of the total workforce (n=4010) The hospital falls under
the Ekurhuleni Metropolitan Municipality It does not have occupational therapists clinical
psychologists dieticians speech therapists and dentists in its permanent staff
443 The ODI District Hospital
The ODI District Hospital is in Region C and is in transition due to boundary changes It is
being transferred from the North West Province to the Gauteng Province The hospital is in
a semi-rural area with a staff component of 118 (n=474) of full-time employees (n=4010)
and falls under Tshwane Metropolitan Municipality It is a general district hospital
444 The George Mukhari Hospital
The George Mukhari Hospital is an academic hospital in Region C under Tshwane
Metropolitan Municipality The hospital trains doctors and employs 010 (n=3) White male
employees 26 (n=739) African males and7184 (n=2097) African females out of the
total female workforce (n=2919)
46
This phenomenon may be as a result of the hospital having the highest general assistants
workforce at 2065 (n=586) out of the workforce (n=2839) The George Mukhari Hospital
has the highest number of general assistants out of the four hospitals represented as 25
(n=719) in a total workforce of n=2836 African employees
45 RESEARCH INTERPRETATION
The interpretation of leave of absence is confined to salary level 1 to 12 full time employees
of the Gauteng Department of Health who took leave of absence from the workplace for the
calendar year in 2008 It excludes the contract employees periodic remuneration foreign
employees and permanent employees above salary range 13
The Basic Conditions of Employment Act 75 of 1997 Section 9 (3) (RSA 1997) prescribes
procedures in terms of progressive reduction of the maximum working hours to the goal of
a 40-hour working week and an eight-hour working day Finnemore and Van Rensburg
(2002462) state that the reduction of maximum working hours to 40 hours a week is done
through collective bargaining with due regard to job creation efficiency and health safety
and welfare of employees Du Toit and Van Der Waldt (1998232) use the formula to
aggregate lost working-man hours due to ill health and disability as aggregate lost hours in
the survey period divided by 40 hours in a week and x number of hours in a year A formula
to work out the absenteeism rate by Pierce (2009) is represented as A=BC A= Absenteeism
rate B= Total number of days lost due to absenteeism in a given period C= Total number of
working- man days available in the given period C=D x E D=Total number of employees
planned to work in the given period E=Number of available working days in the given
period
The approach of the research uses the principle of absence from the workplace when due to
work to identify the lost working hours (Pierce 2009 Davey amp Cummings 2009313) The
study applies a retrospective approach
The working-man lost days for the Province in the four hospitals is approached in terms of
lost working -man days simplified refers to the number of days meant to have been worked
but actually not worked due to illness or disability by the employees in a year divided by the
total number of employees of the public sector (PXVI) Barker (200779) argues that a
reduction in working hours increases the hourly cost of production and unit production
unless there is a commensurate increase in productivity This approach has a similar effect
on workplace absenteeism when the workload of those employees who are present
increases as they carry the double load to meet the demands of service delivery The cost of
absence to the Province is expressed as salary expenditure for each day of leave of absence
from the workplace (PSC 2002 xiii Pierce 2009)
47
The salary range is laid down according to Annexure in DPSA Circular 1 of 2008 The Gauteng
Government experienced a cost estimated at R29 million in 2000 and approximately R54
million in 2001 from absenteeism and loss of working time (Parbhoo20031)
The formula that is used in this research to calculate lost man work-hours is collective
working days of absence multiplied by 8 hours in a working day resulting in the total
working hours that are lost This formula can be represented as
Lost days x hours (8) in a working day = lost working hours
As stipulated by the Basic Conditions of Employment Act 75 of 1997 section 9 1(c) 3
TABLE 6 RACES IN RELATION TO ABSENTEEISM
RACE TOTAL DAYS OF ABSENTEEISM PERCENTAGE
Africans 14295 963
Whites 242 16
Coloureds 201 14
Indians 102 07
TOTALS 14840 100
(Source Compiled by the researcher 2012)
Table 6 represents absenteeism in the diverse races in the workplace The absenteeism rate
seems to be proportional to the number of employees The Employment Equity Act 55 of
1998 defines the term ldquoblackrdquo as a generic term which means Africans Coloureds and
Indians The Africans as a race group is represented by 963 (n=14295) of the total
working days lost (n=14840) The high figure of lost working-man days reflects the
demographics of the four hospitals The George Mukhari Hospital is in a rural setting that is
predominantly African populated and employs the highest number of Africans as
represented in table 3 Whites are presented by 16 and not represented in all
occupational categories and salary ranges that could explain the low figures and
percentages associated with working-man days lost Africans constitute the highest number
of employees as well as the highest percentage of working-man days lost Absenteeism
percentage is proportional to the employment figures for this race group The Indian race
group is represented by the lowest figure of employment and lowest percentage of leave of
absence which is proportional to the employment figure
48
TABLE 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM
OCCUPATIONAL
GROUPS
TARA GERMISTON ODI GEORGE
MUKHARI
TOTALS
DOCTORS 22 118 5 290 435
PROFESSIONAL NURSE 272 346 20 2459 3097
STAFF NURSE 128 247 13 1568 1956
NURSE-ASSISTANT 150 126 25 1145 1446
FINANCE 0 0 0 386 386
ADMINISTRATION 57 272 20 1923 2272
ADMIN SUPPORT 754 547 163 3784 5248
TOTAL 1383 1656 246 11555 14840
(Source Compiled by C S Ndhlovu 2012)
Table 7 reflects the working-man days lost by the different occupational groups The
doctorsrsquo workload in terms of the annual report for Gauteng Department of Health
(2008951) was 226 as against the target of 227 while the national target was 187
The bed occupancy rate target for the same time was 75 while the actual figure was
653 The annual report interpreted in conjunction with the data of leave of absence for
doctors reflects a negative impact in terms of service delivery and the cost factor to the
department
451 Occupational groups in relation to absenteeism
The multi-group invariance structural model presents different types of occupations and is
used to identify variance in the patterns in terms of occupational groups The model allows
different relationships between variables in different occupations The different
occupational groups are doctors professional nurses and sub-categories administration
staff and administration support staff (Pousette amp Hanse 2002230) According to Gaudine
and Gregory (2010599) absenteeism was a problem among health care workers in
comparison to other employees in other sectors The cornerstone of an efficient health care
service delivery is equity and efficiency which is threatened when employees are not at
work when expected to be (Andrews 199734-35 DPSA 1997)
49
According to the Charted Institute of Personnel Development (200811) the survey that was
conducted found that public sector employees are less likely to be disciplined or dismissed
for reasons of workplace absenteeism
Tables 5 and 6 and 7 reflect the different occupational groups and the level of absenteeism
in the four hospitals of the Gauteng Department of Health
4511 Doctors
Doctors are represented by 10 (n=397) of the total working population (n=4010) The
29 (n=435) indicates the number of working-man days lost in relation to the total
working- man days lost (n=14840) The percentage of working- man days lost in relation to
the total number of full time employees of the four hospitals is reflected as 435 divided by
n=4010 times the percentage which results in 108 (n=435) working-man days lost
multiplied by 8 hours that represent a working day The outcome is n=3480 working-man
hours The cost to the Province is calculated in terms of the salary expenditure as direct and
indirect salary payment for lost working-man hours estimated at 3480 hours at salary level
10 at R217 482 to salary level 12 at R 407745 as well as indirect costs such as replacement
of staff and overtime
The doctorsrsquo workload in terms of Gauteng Province 20089 annual report (2008951)
reflects the doctorrsquos workload as 226 as against the target of 227 while the national
target is reflected as 187 The bed occupancy rate target for the same time is 75 while
the actual target rate is 653 The annual report when interpreted in conjunction with the
data of leave of absence for doctors reflects a negative impact in terms of service delivery
and the cost factor to the Department when considering a loss of n=3480 man hours of
work
Chaudhury and Hammer (200311) found in their research that the doctors presented the
highest absenteeism rate Serneels et al (2008210) argue that absenteeism is rife in the
public sector where employees hold two jobs and is highest among doctors The doctor
absenteeism rate in the research does not stand out as high in comparison with the other
occupational groups The doctor absenteeism rate is 29 when compared to the total
workforce This occupational group is represented by 10 of the total population The
doctorsrsquo absenteeism rate does not seem to be outstandingly high in comparison with the
other occupational groups in relation to the total number of permanent doctors
50
4512 Professional nurses
The professional nursesrsquo absenteeism is reflected as 208 (n=3088) that indicates the
number of working-man days lost in relation to the total working-man days lost (n=14840)
The percentage of working-man days lost in relation to the total number of full time
employees (n=4010) in the four hospitals is reflected as 77 The cost to the Province
translates into direct and indirect salary expenditure which is spread from salary level 4 to
12 at R64 410 to R407 745 in 2008 for the total duration of lost working days
Du Toit and Van Der Waldt (1998232) pointed out a crisis in four other public hospitals in
the Gauteng Province that was caused by budget cuts and shortage of doctors and nurses in
2008 The vacancy rate of 697 in the professional nurse category and the absence rate of
208 in 2008 in the four hospitals seem to point to a lack of adequate human resources for
effective health care delivery The extent of working-man hours lost in the findings of the
research suggest a high rate of absenteeism and not a good reflection of happiness as
suggested in the annual report Professional nurses are second to the administration
support in absenteeism at 208 at a total of (n=785) nurses in the four hospitals with
absenteeism of n=3088 working-man days lost or n=20704 working-man hours lost This
category of employees is classified as skilled to highly skilled at salary range of 4 to 12The
total vacancy rate was at 697 as against the national target at 15 in 2008 with
absenteeism of 208 Madibana (201022) found in the research about absenteeism
among nurses that the high rate of absence had a negative impact in the quality of health
care rendered by nurses
4513 Staff nurses
Staff nurses are reflected in tables 4 and 5 as representing 12 (n=482) of the total working
population (n=4010) The 132 (n=1956) indicates the number of working-man days lost
in relation to the total working-man days lost (n=14840) times the percentage
The percentage of working-man days lost in relation to the total number of full time
employees in the four hospitals is reflected as 488 The cost to the Department is
expressed as direct and indirect salary expenditure for n=15648 working-man hours lost
The impact of leave of absence to health care services and cost to the Department is the
same as the professional nurses as staff nurses are a sub-category of the nursing profession
4514 Nursing assistants
Nursing assistants are reflected in tables 4 and 5 as represented by 107 (n=429) of the
total working population (n=4010) and 97 (n=1446) represent working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The
percentage of working-man days lost is reflected as 36 (n=1446) in relation to the total
number of employees in the four hospitals (n=4010)
51
The cost of leave of absence to the Department is expressed as the salary expenditure at
salary levels 3 to 6 Salary level 3 is at R54 876 salary level 4 is at R64 410 salary level 5 at
R76 194 and salary level 6 is at R94 000 for n=11568 working-man hours lost and staff
replacement and overtime
4515 Finance officers
Finance officers are reflected in tables 5 and 7 as represented by 21 (n=83) of the total
working population (n=4010) and 26 (n=386) indicates the working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The cost to the
Department is reflected as salary expenditure from salary level 2 at R47 787 to salary level
10 at R217 482 for R2 728 working hours lost The institutions reflected a small number of
this occupational category as permanent employees place them in the category of scarce
skills
4516 Administration staff
The administration staff is represented in tables 2 and 4 and 5 by 116 (n=466) in the total
working population (n=4010) and 153 (n=2272) indicates the working-man hours lost in
relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 567 represent the working-man days lost in relation to the total number of
full time employees in the four hospitals (n=4010) The cost of leave of absence to the
department is reflected as salary expenditure at salary level 4 to 12 Salary 4 at R64 410 to
salary level 12 at R407 745 for 18176 working hours lost
4517 Administration support
The administration support is reflected in tables 2 and 4 and 5 as represented by 273
(n=1095) of the total working population 354 (n=5248) indicates the working-man days
lost in relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 1309 (n=5248) indicates the working-man days lost in relation to the total
number of employees in the four hospitals (n=4010) The total cost to the Department is
reflected as salary expenditure at salary level 2 to 3 at a cost of R47 787 to R54 879 for
41984 working -man hours lost
The highest percentage of absenteeism in the different categories of employees in the four
hospitals is identified in the administration support category It is this category that falls into
the salary range of 2 and 3 which is classified in the Gauteng Province 20089 annual report
(20089325) as lower skilled employees This category represents the highest single
category of employees for the Department at n=1095
52
The impact to the core service delivery employees that require support from administration
staff would seem to be negative as the absence of employees from the workplace would
hamper the smooth workflow Barker (2007214-224) acknowledges the decline in the flow-
through rate in the school education higher grades namely Grade 11 and Grade 12 and
ventures to give possible reasons for this phenomenon The Gauteng Department of Health
as a possible employer has attracted a high percentage of the labourer category as
identified in table 3 totalling n=1095 which is 273 of the total workforce Pousette and
Hanse (2002230-231) suggest that the employeersquos authority to make decisions in his or her
job and the breadth of use of skills used by the employees at work become different aspects
of control with human service at work This approach suggests that reduced job autonomy is
associated with higher sickness absence The administrative support employees are involved
in mechanical or manual labour that predisposes them to musculo-skeletal problems The
work environment could have a negative impact to the high absenteeism rate in this group
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM AS REPRESENTED BY
THE HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 43 reflects the absenteeism rate of the different occupational groups as represented
by the hospitals The George Mukhari Hospital contributes 7079 to the total workforce
and contributes about 779 to absenteeism The absenteeism rate does seem to be low at
7 when considered in the light of the contribution The question that maybe be raised is
whether the relative low absenteeism is indicative of high morale of a happy workforce
53
ODI 17
TARA 93
GERMISTON 111
GEORGE MUKHARI 779
Germiston Hospital contributes 106 to the total workforce and the absenteeism is
reflected as 111 which seems to be above its contribution to the workforce by 1 The
professional nurse and the administration category present with the highest rate of
absenteeism in this hospital The Tara Moross Centre Hospital contributes 67 of the total
workforce and the absenteeism rate is at 93 which is 26 higher The administration
support and professional nurses present with the highest level of absenteeism in this
hospital The ODI Hospital contributes 6 to the total workforce and the absenteeism rate
which seems to be low is reflected as 17 This hospital has no access to the Persal system
and is dependent to a neighbouring hospital It is highly probable that the information is not
accurate
Allen (1984 331) found that union members might be absent more frequently from the
workplace than non-members because they face smaller penalties for absenteeism The
Charted Institute of Personnel and Development (CIPD) (200811) claim that the 2006
survey of absence management portrays the public sector employees as less likely to be
dismissed for reasons of workplace absenteeism
TABLE 8 SALARY RANGE IN RELATION TO ABSENTEEISM (SALARY RANGE 1-12)
SALARY RANGE DAYS OF ABSENCE PERCENTAGE
1-2 178 12
3-4 5235 353
5-6 2044 138
7-8 5139 346
9-10 1878 126
11-12 366 25
TOTAL 14840 100
(Source Compile by the researcher C S Ndhlovu 2012)
Table 8 reflects the salary range with the lowest working days lost as salary level 1 to 2 This
is proportional to the number of employees The highest absenteeism rate has been noted
in the salary range at level 3 to 4 while salary ranges at level 11 to 12 reflected a low rate of
absenteeism The latter salary range is at middle management level and the responsibility
the employees carry may be responsible for the low absenteeism rate Rogers and Hertin
(1993219) noted that the level of education seem to have influenced the use of sick leave
where the lower level category employees were found to have higher level of absenteeism
than higher educated employees
54
TABLE 9 AGE IN RELATION TO ABSENTEEISM
AGE IN YEARS DAYS OF ABSENCE PERCENTAGE
20 to 24 16 010
25 to 29 405 272
30 to 34 733 493
35 to 39 1582 1066
40 to 44 2676 1803
45 to 49 3318 2235
50 to 54 3046 2052
55 to 59 2235 1506
60 to 64 829 558
TOTAL 14840 9999(100)
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 9 reflects age in relation to absenteeism in the four hospitals The age group at 20 to
24 years reflects the lowest figure in working-man days lost at 010 (n=16 days)
Reday-Mulvey (200579) observed that employees over 45 years take marginally fewer short
sick leave days per year than those under 45years
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 to 55 years
as middle -age and shows this group as presenting with a high incapacity leave usage In the
research the age group 45 to 49 years presented with 2235 (n=3318) working-man days
lost and is the highest figure of absenteeism in all age groups The age group at 20 to 24
years is reflected as the lowest absenteeism rate in working-man days at 010 and this
could be related to the number of employees in this age group
According to Reday-Mulvey (20057988) and the Canadian Nurses Association (20065)
employees that are over 45 years take marginally fewer short sick leave periods but take
slightly longer sick days per year than those under 45 years and reflect higher absenteeism
in the age group above 50 years
55
Weeks (200454) found that employees at the age group represented by 51 to 60 years
show less absence which may be because of ill health retirement benefits The age 31 to 40
and 41 to 50 years show higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full time jobs and suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee In the study the age group 55 to 59 years show a decline in absenteeism in
comparison to 50 to 54 while age 60 to 64 shows the lowest rate
The aging employee has been found to expose the institutions to high levels of absenteeism
through a higher probability of becoming incapacitated for longer periods (Ferguson et al
200138) and the current research have pointed differently Rogers and Hertin (1993219)
found a significant correlation between the use of sick leave and age suggesting employees
with advanced age used more sick leave in comparison with the younger employees The
current socio-economic culture encourages retirement from active employment at the age
of 65 years and the research adopted that approach as a cut off point for employment
(Nichols amp Evangelisti 2001285)
TABLE 10 GENDER IN RELATION TO ABSENTEEISM
GENDER TOTAL
NUMBER
DAYS OF
ABSENCE
PERCENTAGE
Males 1006 2490 168
Females 3004 12350 832
Total 4010 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 10 reflects gender in relation to absenteeism The duration of working-man days lost
is higher in female employees at 8325 (n=12350) and is represented by 749 (n=3004) in
relation to the total number of employees in the four hospitals (n=4010) as represented in
table 3 The male employees employed by the Department are reflected as absent from
work by 1680 (n=1006) and represented as 251 in relation to the total number of
employees in the four hospitals (n=4010)
The Public Service Commission (PSC 200222) found that more males took sick leave than
females except for the age group of 16 to 19 years QUALSA (200923) noted that females
had the highest number of incapacity applications in comparison to their male counterparts
Qualsa attributed this pattern to the fact that female employees constitute a higher
percentage of the employee population within the Gauteng Department of Health
56
Roger and Hertin (1993222) noted that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees could have an
impact on the high number of absenteeism reflected by the women
452 Race in relation to absenteeism
The working population of the four hospitals is represented by four race groups such as
Africans Whites Coloureds and Indians
4521 Africans
Africans represent 973 (n=3902) of the total working population (n=4010) and 963
(n=14295) indicates the working-man days lost in relation to the total working-man days
lost (n= 14840) times the percentage 3565 (n= 14295) reflects the working-man days
lost in relation to the total number of employees in the four hospitals (n=4010) The 14295
working-man days lost are multiplied by 8 hours that represent a day and translates into
963 (n=114360) working-man hours lost The cost to the Department is translated as
salary expenditure for n=114360 workingndashman hours lost and the indirect cost of staff
replacement and overtime Africans constitute the highest number of employees as well as
the highest percentage of working-man hours lost Absenteeism percentage is proportional
to the employment figures for this race group
4522 Whites
Whites are represented as 13 (n=51) of the total workforce (n=4010) and 16 (n=242)
represent the working-man days lost in relation to the total working-man days lost
(n=14840) times percentage 61 (n=242) represent working- man days lost in relation to
the total number of employees in the four hospitals The 232 working-man hours lost are
multiplied by 8 hours that represent a working- man day that translates into 16 (n=1856)
working-man hours lost The cost to the Department is represented as salary expenditure of
(n=1856) working-man hours lost that is paid to the unproductive employees This race
group of employees is not represented in all occupational categories and salary ranges
which may explain the low figures and percentages associated with working-man days lost
(n=242) The demographics of the different hospitals may contribute to the low
representation of this group in the total workforce
4523 Coloureds
Coloureds are reflected as 11 (n=43) of the total workforce (n=4010) 14 (n=201)
represent working- man days lost in relation to the total working- man days lost (n=14840)
5 (n=201) indicates working- man days lost in relation to the total number of employees in
the four hospitals (n=4010)
57
The cost to the department is represented as salary expenditure for n=1608 working-man
hours that are lost This race group is represented in three of the four hospitals and not in
all categories and salary ranges which may explain the low representation and
absenteeism
4524 Indians
Indians represent 03 (n=14) of the total workforce (n=4010) in table 6 07 (n=102)
represent working- man days lost in relation to the total working- man days lost (n= 14840)
times percentage 25 (n=102) indicates working- man days lost in relation to the total
number of employees in the four hospitals (n=4010) The 102 working- man days lost are
multiplied by 8 hours that represent a working-man day and translates into 07 (n=816)
working- man hours lost The cost to the Department is expressed as salary expenditure
paid to the unproductive employees for duration of (n=816) working-man hours lost This
race group is not represented in two of the four hospitals in some occupational categories
and salary ranges The Indian race group is represented by the lowest figure of employment
and lowest percentage of leave of absence which is proportional to the employment figure
FIGURE 44 RACES IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 44 reflects the different races in relation to absenteeism The Africans as a race
group is represented by 963 of working-man days lost (n=14840) The high figure of lost
working-man days reflects the demographics of the four hospitals
58
14840 DAYS
(100)
Africans 963
whites 16
coloureds 14
Indians 07
The George Mukhari Hospital is in a semi-rural setting that is predominantly African
populated and employs the highest number of Africans as represented in table 1 (n=2836)
Whites are presented by 16 absenteeism rate and not represented in all occupational
categories and salary ranges which could explain the low figures and percentages associated
with lost working days The absenteeism rate for Indians is represented as 07 and
Coloureds as 14
The Africans as a race group constitute the highest number of employees as well as the
highest percentage of working days lost Absenteeism percentage is proportional to the
employment figures for this race group The Indian race group is represented by the lowest
figure of employment and lowest percentage of leave of absence which is proportional to
the employment figure The South African Survey Millennium (1999-200028) reflected the
African males in 1998 as 354 and females as 348 the Coloured males as 39 and
females as 46 Indian males as 39 and females as 15 and White males as 83 and
females as 94 There has been no significant change in the race group representation in
the working population of the four hospitals
453 Tenure in relation to absenteeism
Tenure in years is grouped in units of ten (10) Tenure in 1 to 10 years 11 to 20 years 21 to
30 years 31 to 40 years of all occupational groups are represented in figure 27 as the total
leave of absence utilised by the full-time employees of different occupational groups in
terms of tenure which translates into n=14840 working-man days lost The lowest hours lost
is at tenure 31 to 40 years of service which is reflected as 59 (n=878) working- man days
lost The highest working-man days lost is at tenure of service of 11 to 20 years reflected as
443 (n= 6577) working- man days lost Tenure of service of 1 to 10 years reflects 30
(n=4451) working-man days lost and tenure of years at 21 to 30 years reflects 198 (n=
2934) working- man days lost
Rogers and Hertin (1993222) express tenure as work experience in years that is viewed as a
predictor of employee productivity where seniority has been found to be inversely related to
absenteeism in terms of frequency and total number of work days lost The Canadian Nurses
Association (20065) suggests that job tenure increases with age as illustrated in their
research where nurses were found to have both job tenure of 20 years or more and are over
45 years of age In the research the tenure of 31 years to 40 years presented with the lowest
absenteeism rate in agreement with Rogers and Hertin (1993222)
59
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 45 reflects the total leave of absence from tenure of 1 year to 40 years The PERSAL
system reflected 40 years as representing more or less 64 years of age and 65 years is the
cut off point for full time employees in the system The lowest working- man days lost is at
tenure of 31 to 40 years of service which is reflected as 590 and represents the older
employee in general The highest working- man days lost is reflected at tenure of 11 to 20
which is presented as 4430 representing the younger employee This is an area of concern
as table 5 reflects professional nursesrsquo absenteeism rate at 208 and administration
support staff at 356 and is possible that the absenteeism rate of the two occupational
categories may be a bigger contributor to the high absenteeism rate reflected in the tenure
of 11 years to 20 years
454 Salary range in relation to absenteeism
The salary range is interpreted in the study as a salary broad band that is represented in
table 9 and ranges from level 1 to 12 Rogers and Hertin (1993 219) claim that the level of
education does seem to have a bearing on the salary range use of sick leave where the
lower level category employees were found to have higher levels of absenteeism than the
higher educated employee The Human Resource Development Strategy (Gauteng Province
200815214) claims that the chances of entering into a higher income bracket in South
Africa rises noticeably after people have twelve years of education The ages 20 to 24 years
are greatly affected by this assumption
60
0
20
40
60
Tenure 1-10Tenure 11-20
Tenure 21-30Tenure 31-40
30 4430
1980
590
Tenure
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 46 above reflects the salary range from 1 to 12 in relation to working- man days lost
as salary range 1 to 2 as n=178 working-man days lost which converts to 12 The highest
absenteeism rate has been noted in the salary range at level 3 to 4 at 3530 (n=5235)
working-man days lost while salary ranges at level 7 to 8 is reflected as the second highest
level of absenteeism at 346 (n=5139) lost working-man days
Salary range at 5 to 6 is reflected as the third highest in absenteeism at 138 (n=2044) lost
working-man days Salary range 9 to 10 is regarded as the entry point to middle
management and is reflected as the fourth highest at 126 (n=1878) working-man days
lost Salary range at 11 to 12 is regarded as middle management entrusted with high levels
of authority and accountability This group is reflected as losing 25 (n=366) working- man
days lost which is considered to be a reasonable low level of absenteeism
455 Age of full time employees in relation to absenteeism
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 years to 55
years as middle-age and shows this group as presenting with a high incapacity leave usage
In the research the age group of 45 years to 49 years is represented with 2235 (n=3318)
working- man days lost and is the highest figure of absenteeism in all age groups
61
178
5235
2044
5139
1878
366
0
1000
2000
3000
4000
5000
6000
Salary range1-2
Salary range3-4
Salary range5-6
Salary range7-8
Salary range9-10
Salary range11-12
DAYS OF ABSENTEEISM
Reday-Mulvey (20057988) and Canadian Nurses Association (20065) observed that
employees over 45 years take marginally fewer short sick leave periods but take slightly
longer sick days per year than those under 45 years and reflect higher absenteeism in the
age group above 50 years
Weeks (200454) claims that the age group at 51years to 60 years show less absence may be
because of ill health retirement benefits The age group of 31 years to 40 years and 41years
to 50 years show a higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full-time jobs He suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee The aging employee has been found to expose the institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods
(Ferguson et al 200138)
Rogers and Hertin (1993219) claim that there is a significant correlation between the use of
sick leave and age suggesting employees with advanced age comparatively used more sick
leave in comparison with the younger employees The current socio-economic culture
encourages retirement from active employment at the age of 65years and the research
adopted that approach as a cut off point for employment (Nichols amp Evangelisti 2001285)
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 47 reflects the number of working-man days lost by full-time employees through
absenteeism related to a specific age
62
16
405
733
1582
2676
3318
3046
2235
829
0
500
1000
1500
2000
2500
3000
3500
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Days of absence
Days of absence
Age groups are organised in units of 5 to be consistent with the Personnel and Salary
Administration System (PERSAL) The age group at 20 years to 24 years reflects the lowest
percentage of absenteeism at 010 (n=16) working-man days lost and the age group of 45
years to 49 years reflect the highest days of absenteeism at 2235 (n=3318)
456 Gender in relation to absenteeism
The females employed in the Department of the four hospitals are represented as 749
(n=3004) in relation to the total number of employees in the four hospitals (n=4010) and
lost 8320 (n=12350) working-man days This absenteeism rate is considered high
considering that not every female employee may have used sick leave The male employees
employed in the Department are represented by 25 (n=1006) of the total workforce
(n=4010) and lost 168 (n=2490) working-man days The findings suggest that males
utilised fewer days of sick leave considering the fact that not every male employee may
have utilised sick leave for the duration of the study
The Public Service Commission (PSC 200222) claims that more males took sick leave than
females except for the age group of 16 years to 19 years QUALSA (200923) noted that
females had the highest number of incapacity applications compared to their male
counterparts Qualsa attributed this pattern to the fact that female employees constitute a
higher percentage of the employee population within the Gauteng Department of Health
Rogers and Hertin (1993222) argue that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees may have an
impact on the high rate of absenteeism
63
FIGURE 48 GENDER IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 48 reflects gender in relation to absenteeism The females employed by the
department in the four hospitals are reflected as absent from work at a rate of 8320
(n=12350) working-man days and represented by 749 (n=3004) in relation to the total
number of employees (n=4010) in the four hospitals The male employees employed by the
Department are reflected as absent from work at 1680 (n=2490) and represented as
251 (n=1004) in relation to the total number of employees in the four hospitals
(n=4010)
457 Week days in relation to occupational groups
Table 11 reflects the trends in terms of days of the week that show high utilisation by the
different occupational groups Mondays Fridays and Thursdays reflect a high utilisation rate
by the employees suggesting a pattern of high absenteeism rate over weekends
Professional nurses and sub-categories and the administration support group reflected the
highest absenteeism over the weekends
64
1680
8320
000
1000
2000
3000
4000
5000
6000
7000
8000
9000
Males Females
GENDER ABSENCE
TABLE 11 WEEK DAYS IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
OCCUPATIONAL
CATEGORY
MONDAY TUESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Doctors 18 8 13 17 0 0
Professional
Nurse
135 86 94 137 0 0
Staff Nurse 52 38 56 65 2 0
Nursing
Assistant
62 27 34 45 2 0
Administration
Staff
64 38 58 73 1 0
Administration
support
252 147 98 126 26 15
Finance officer 17 4 8 16 0 0
TOTAL 600(4) 348(23) 361(24) 479(32) 31(02) 15(010)
(Source Compiled by C S Ndhlovu 2012)
Table 11 reflects the pattern of how the different occupational groups utilised sick leave on
the different days of the week It illustrates the days that sick leave started on each day of
the week The largest number of incidences of sick leave commence on Monday the first
working day of the week as reflected by 4 (n=600) of the days of the weekend Fridays are
the second highest days of absenteeism represented by 32 (n=479) Tuesdays and
Thursday are almost the same in utilisation as reflected by 23 and 24 respectively
Professional nursesrsquo absenteeism was pronounced on Mondays as 2250 (n=135) and
Fridays as 2861 (n=137) a trend that shows possible long weekend absenteeism
The administration support staff has been reflected as mostly absent on Mondays 42
(n=252 days) and Fridays 2631 (n=126 days) The administration support reflected the
highest days of absenteeism on Saturday (n=26) and Sunday (n=15) The Canadian Nurses
Association (CNA) (2006) focused on seasonal pattern of absenteeism in the different
categories in the different hospitals The PSC (2002) report identified a trend by provincial
employees of using sick leave to extend their weekends The research considered working-
man days lost in terms of days of absence as in accordance with evidence of a medical
certificate Administration support is the only group that seem to have utilised Saturdays
for sick leave 8387 (n=26) and Sundays 100 (n=15) days
65
TABLE 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALS
INSTITUTIONAL
CONTRIBUTION
TARA MOROSS
CENTRE
GERMISTON ODI GEORGE
MUKHARI
TOTAL
Contribution to
Sample
668 1070 1182 7080 100
Contribution to
Absenteeism
842 1177 165 7816 100
(Compiled by C S Ndhlovu 2012)
Table 12 reflects the contribution of each hospital to absenteeism Tara Moross Centre
Hospital contributed 67 to the sample and the absence rate is higher than the
contribution at 84 The Germiston Hospital contributed 107 to the sample and the
absenteeism rate is higher at 117 The George Mukhari Hospital contributed 708 to the
sample and absenteeism rate is at 782 and ODI Hospital contributed 118 and
absenteeism rate is at 17 The latter hospital has no computers at The reflection of the
status of absenteeism is likely to be inaccurate The George Mukhari Hospital has the
highest contribution to the sample yet leave of absenteeism is tolerable It raises questions
as to what should be the contributory factor to the leave of absence status in this hospital
46 CONCLUSION
Chapter 4 presented the analysed data in terms of the characteristics as determined in the
stratified random sampling The characteristics and their association with absenteeism have
been presented such as occupational categories age gender tenure of service and race
The research identified which days of the week were utilised for sick leave absence The
contribution of each hospital to absenteeism was identified and a brief overview of each
hospital was presented
Chapter 5 presents the findings conclusion and recommendation of the research
66
CHAPTER 5
FINDINGS CONCLUSIONS AND RECOMMENDATIONS
51 INTRODUCTION
Chapter 1 provides a general introduction to the research It included the background and
motivation for the research that provides the context the problem statement and the
significance of the research The key concepts are defined The research design the method
of data collection the sampling method data analysis and interpretation and limitations to
the research are explained in this chapter
Chapter 2 considers the theoretical foundations concepts characteristics theories
approaches and classifications of workplace absenteeism The discussions on the conceptual
framework of absenteeism predictors of absenteeism and various models of absenteeism
are presented Measures to control workplace absenteeism and the impact of absenteeism
in an institution and management intervention strategies in workplace absenteeism were
discussed
Chapter 3 describes the research design and the different aspects of the research methods
that were applied to the research The chapter explains the various data collection
techniques that are used unit of analysis units of observations construct validity and
ethical considerations
Chapter 4 provides the organisational structure of the Gauteng Department of Health
comparisons of hospital employees different race groups of the four hospitals gender
comparisons in different hospitals and comparisons of the different occupational groups It
provides a short description of the target hospitals The research interpretation is discussed
in terms of the different occupational groups and absenteeism different races and
absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism The trends of week days of
absenteeism in the four hospitals and contributions to absenteeism by the four hospitals are
presented
Chapter 5 explains a synthesis of the study and evaluation of workplace absenteeism The
findings of the research and recommendations are discussed
52 FINDINGS
The findings of the research reflect doctors as represented by 108 in the total workforce
(n=4010) have an incidence of 29 (n=435) of the total work-man days lost (n= 14840) by
the employees in the four hospitals translating to a total of n=3480 working hours lost
67
The working-time lost is considered against the doctorsrsquo workload of 226 in contrast to the
target of as 227 while the national target was 187 The bed occupancy rate target was 75
while the actual figure was 653 The annual report when it is interpreted in conjunction
with the sick leave absence of doctors at 29 shows no negative impact on the workload in
terms of service delivery The negative impact is mainly on the cost factor to the state as the
doctorrsquos salary level is from salary level 10 at a cost of R217482 to salary level 12 at
R407745 (Gauteng Province annual report 2008951) Serneels et al (2008210) claim that
absenteeism occurs primarily in the public sector associated with people who hold two jobs
and that is highest and more frequent amongst doctors The findings of the research of
absence of 29 with a contribution of 2 to the sample are in disagreement with the
Serneels et al findings
Professional nurses represent 196 (n=785) of the total workforce (n=4010) The
workplace absenteeism is represented as 77 (n=3088) of the total workforce (n=4010)
translating into 21 of working-man days that are lost (n=14840) The absenteeism rate
appears to be very high given the fact that nurses by virtue of their numbers are the
backbone of health care service delivery (DPSA 2009) The Gauteng Province annual report
of 2008951 reflects the total vacancy rate of nurses at 697 as against the national target
of 15 The absenteeism rate of 77 is very high when compared with the total vacancy
rate and 19 contribution to the sample Staff nurses are a sub-category of the nursing
profession and the impact of their absence to service delivery is the same as the
professional nurses The findings of the study reflect staff nurses representing 12 (n=482)
of the total working force (n=4010) The absenteeism from staff nurses is reflected as 13
(n=1956) of the total working-man days lost (n=14840) The absenteeism rate does appear
to be high when considering the contribution of 13 to the absence rate by a sample of 12
to the total working-man days lost Nursing assistants are a sub-category of the nursing
profession that is reflected as 107 (n=429) of the total number of employees (n=4010)
and represent 97 (n=1445) of the total working-man days lost (n=14840) This absence
rate is considered as high when compared with the total number of employees
The nursing occupational group considered collectively contributed to absenteeism at the
workplace at 997 which is extremely high Davey and Cummings (2009312-313) claim
that frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased
staff morale and high cost to health care The high absenteeism rate has a negative impact
on health care service delivery
The findings of the research reflect administration staff as 116 (n=466) of the total
number of employees (n=4010) represented by 154 (n=2286 days) of the total working-
man days lost (n=14840) Administration support is at salary level 1 to 2 with exceptional
instances of salary level 3 to 4
68
Administration support staff is reflected as 273 (n=1095) of the total workforce (n=
4010) represented by 356 (n=5289 days) of the total working-man days lost (n=14840)
translating to n=42312 lost working-man hours
The administration staff viewed collectively contributed 51 to absenteeism which is very
high with the support staff reflected as 356 Rogers and Hertin (1993219) claim that the
level of education seem to have influenced the use of sick leave where the lower skilled
category of employees were found to have higher levels of absenteeism than higher
educated or skilled employees The findings of the research reflect the administration
support staff to be in line with the Roger and Hertin findings
The Gauteng Department of Health has a limited number of finance officers causing them to
be a scarce skill occupational group The finance officers represent 2 (n=83) of the total
workforce (n=4010) The working-man days lost are reflected as 23 (n=341) of the total
working-man days lost (n=14840) The total absence at 23 is higher than the actual
contribution to the sample at 2
The age group of 45 years to 49 years reflects the highest absenteeism rate at 224
(n=3318) the age group at 50 years to 54 years is reflected as 205 absenteeism The age
group 40 years to 44 years reflected as 18 absent from the workplace The age group of 55
years to 59 years is reflected as 15 absenteeism Employees of advanced age used more
sick leave in comparison with the younger employees This phenomenon could be attributed
to the ageing process of the body and the onset of incapacity Absenteeism has been found
to be higher in employees who are over 50 years of age and the phenomenon is attributed
to age and changing abilities that increase when work is performed full- time The findings
of the research reflect the age group over 50 years at 205 and reflect the highest
absenteeism rate at age 45 years to 49 years as 224 (McGoldrick amp Arrowsmith 200184
MINTRAC 20093 Nichols amp Evangelisti 2001285 Reday-Mulvey 200579-194) According to
Ferguson et al (200138) the aging employee presents with high levels of absenteeism
through higher probabilities of becoming disabled for longer periods The findings of the
study reflect absenteeism of the age group of 55 years to 59 years at 15 which is the
lowest in the age groups The Canadian Nurses Association in (20065) noted a reduction in
workplace absenteeism rate among nurses who are less than 45 years of age and an
increase in the absenteeism rate among nurses above 55 years of age According to Bangali
(20043-4) the falling rate of the older employee age group could be influenced by the
practice of early retirement or voluntary severance which was used in the 1990s as a
method of restructuring in institutions Rogers and Hertin (1993219) claim employees with
advanced age used more sick leave in comparison with the younger employees
69
The group at tenure 11 to 20 years presented with the highest level of absenteeism at
443 The employee at tenure of 21 to 30 years presented with 198 of absenteeism rate
while the employees at 1 to 10 years presented with the rate of 30 The findings of the
research reflected tenure of 31 to 40 years to have presented with the lowest absenteeism
rate at 59 (n=878 days) This low absenteeism rate could be ascribed to the fact that
numbers of employees are reduced in this group or could also be commitment to their jobs
or could have higher ambition levels to aspire to higher posts
Van Der Westhuizen (2006136) and Rogers and Hertin (1993222) express tenure as work
experience that may be viewed as a predictor of employee productivity where seniority has
been found to be inversely related to absenteeism in terms of frequency and total number
of working-man days lost The public service employees enjoy security of tenure which may
contribute to the unacceptably high levels of absenteeism (Andrews 1997221ndash222
MINTRAC 20093)
The findings of the research reflect females as 75 of the total workforce (n=4010)
represented by 832 (n=12350) of the total working-man days lost (n=14840) The males
represent 25 of the total workforce (n=4010) and are reflected as absent at 168
(n=2490) of the total days of absence (n=14840)The absenteeism rate is very high for
females in this research Rogers and Hertin (199322) and Van Der Westhuizen (2006136)
suggest that women are absent from workplace more than men are Landstad et al (20011)
found that women cleaners who received preventive personnel support depicted a
reduction in absenteeism rate Hoxsey (2010562) claims that although women presented
with a high score of job satisfaction than men they maintained higher levels of
absenteeism MINTRAC (20094ndash8) found that gender moderates the age turnover
relationship Women are more likely to remain in their jobs the older they get than men do
The findings of the research reflect Africans as represented by 26 of the working
population and utilised 963 of the total working-man days lost due to sick leave It is
possible that the overall number of Africans influenced what seems to be a high level of
absenteeism at 963 Whites represented 03 of the working population and
absenteeism is reflected as 16 of the total working-man days lost Coloureds are
represented by 03 of the working-man population and absenteeism was recorded as 14
of the working-man days lost The Indians are represented by 01 of the total working
population and are reflected as 07 of the working-man days lost
The findings of the research reflect the salary range at level 11 to 12 utilised 25 working-
man days for sick leave salary level 7 to 8 which is the supervisory level utilised 346
working-man days lost salary level 3 to 4 which is the entry level of skilled workers utilised
353 working-man days lost The findings suggest management used fewer days of sick
leave in comparison to the supervisory level and entry skilled worker level
70
This can be ascribed to the fact that they are ultimately responsible for the institutionrsquos
effectiveness and productivity
The George Mukhari Hospital contributed 708 to the sample and reflected 771
absenteeism which is relatively low in comparison to the size of the contribution It could be
that processes and procedures of controlling leave of absence are in place The Tara Moross
Centre Hospital contributed 67 to the sample and reflected 93 absenteeism rate that is
high by 26
Professional nurses reflected a trend of high absence over the weekend including
Thursdays This could be a sign of burn out and extending the period of rest from possible
high workloads resulting from high vacancy rates (Gauteng Province annual report 20089)
Nyathi (200059) and the PSC (2002) found that employees are absent from work because
they want to prolong the weekend
53 CONCLUSIONS
The absenteeism rate is very high for females in this research The aging employee presents
with high levels of absenteeism through higher probabilities of becoming disabled for longer
periods The use it or lose it approach of the current system rewards the abuse of sick leave
as it is viewed as not being beneficial by the employees to act responsibly towards the use
of sick leave
The vacancy rate of 697 in the professional nurse category and the absence rate of 208
in 2008 in the four hospitals can only suggest inadequate levels of human resource for
effective efficient quality health care services at a high cost to the Province The nurses
may not be aware of the actual absenteeism or they under-estimate it The combination of
high registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery
Professional nurses and administration support staff have absented themselves from the
workplace predominantly on Mondays and Fridays It could be for various reasons ranging
from feelings of burn out to extending the weekend
The percentage of working-man days lost in relation to the total number of full-time
employees in the four hospitals is reflected as 488 which is very high as there is no
deterrent not to abuse sick leave in the public sector The findings of the research found a
significant correlation between the occupation and use of sick leave age and the use of sick
leave gender and use of sick leave and tenure and use of sick leave
71
The biggest hospital George Mukhari presented the lowest rate of absenteeism for its size
and complexity which reflects an empowered management The Tara Moross Centre
Hospital is the smallest hospital highly specialised and presented with high rate of
absenteeism for its contribution which may be a reflection on the skills of its management
or the type of health care service that is offered by the institution
The international norm of absenteeism is 3 The research established the absence rate at
488 The Gauteng Department of Health is held at ransom by the five trade unions it has
signed agreements with and that makes it difficult for managers to manage absenteeism
The practise of Gauteng Department of Health Head office to remove managers from
institutions when there is a labour unrest exacerbates the problem of managing
institutions
The findings of the research could not establish a representative reflection of race and
absenteeism as Indians Coloured and Whites were not represented in some institutionsrsquo
demographics
54 RECOMMENDATIONS
The White Paper on Transforming Public Service holds management responsible for
delivering specific levels of services and for obtaining value for money in wider utilising of
resources This strategy is to be translated into action The Gauteng Department of Health
should probably benefit by adopting the total absence management philosophy by
cultivating a culture that is not tolerant of high levels of absenteeism through building it in
as a key performance area of the performance of all managers and all employees The
current performance dimension system should lay explicit emphasis on this aspect
The re-engagement of knowledge based and professional retirees at reasonable
remuneration levels to reward their expertise may assist in reviving good work ethics by
mentoring the new and generally young recruits The retired professionals are currently
resisting the call for re-employment on a contract basis at entry level
The Gauteng Department of Health can encourage flexitime in terms of 58 or 68 to allow
the mature employee to remain within the system with the view to share their knowledge
and skills with the young employees who may be highly qualified but lack experience This
approach may deal with the need for adequate human resources for health care delivery at
reduced cost as two employees on flexitime basis can occupy one full-time employeersquos post
Managers should use the return-to-work counselling strategy to solicit feedback from the
employee about the actual absenteeism The counselling should be on a one-to-one basis
This approach may raise self-awareness to the employees in terms of the impact of the
employeersquos absence frothed workplace
72
Currently this intervention strategy is not adequately utilised for fear of confrontation with
labour representatives
Managers should have attendance policies in place effectively communicate policies to
employees adhere to policies and procedures and use absence control strategies
consistently This approach will minimise the feeling of injustice by employees Currently the
human resource unit is challenged by a high staff turnover due to promotions from the
human resource area a situation that creates a vacuum and lack of continuity weakening
the process of empowering line managers by human resource practitioners This high staff
turnover may be controlled through upgrading of the human resource salaries as the
salaries fall out of the occupation service dispensation (OSD)
Managers in the public service are expected to be responsible and accountable for their
portfolios including management of leave of absence and should not shift it to the human
resource unit as is currently the practice It should be possible to charge a manager as an
accomplice for failing to manage the absence of employees where there is no evidence of
corrective remedial action where it has been warranted The researcher takes cognisance of
the fact that the public service is highly unionised and this approach may trigger industrial
action
The employer needs to revive on the job in-service education and training as a way of
imparting institutional values such as attendance at the workplace in partnership with
recognised labour representatives through bilateral and multilateral forums and through
institutional skills development committee which should be representative of all
stakeholders with the view to promote stability in the workplace and indirectly enhance
productivity and reduce workplace absenteeism Currently the bilateral multilateral and
skills development committees are inactive in the institutions that were targeted and
management seems to be intimidated by the militant labour representatives
High levels of absenteeism among some occupational groups do suggest a need for an active
employee assistance programmes at all hospitals Employee wellness committees are
currently inactive There is a sporadic intervention approach at some institutions where
PILIR Committees are active Employee assistance programmes should be budgeted for as a
standing on-going programme in all hospitals There is a need for a thorough research as to
why absenteeism remains high in the public service and focus on absenteeism broadly
73
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Kenwyn Juta
74
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Camp S amp Lambert EG 2005 The influence of organizational incentives on absenteeism
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report Charted Institute of Personnel and Development July Reference 4513 Available at
httpwwwcipdcouk (Accessed on 10072011)
Cloete JJ 2004South African public administration and management2ndimpression
Pretoria Van Schaik
Clark RL 2007The emergence of phased retirement economic implications and policy
concerns Ontario John Deutsch Institute for the study of economic policy
Dagmara S 2000Whorsquos minding the hospitals Absenteeism soars HampHN Hospitals amp
Health Networks 74 (4) April 14ndash143 Available at httpwwwoasisunisaacza(Accessed on
20072011)
Davey MMamp Cummings G 2009 Predictors of nurse absenteeism in hospitals a
systematic review Journal of Nursing Management 17 312ndash330 Available on httpO-
webebscohostcomoasisunisaacza (Accessed on 30072011)
Department for Public Service and Administration1997White paper on transforming public
service delivery Pretoria Public Service Commission
75
Department of Public Service and Administration 2007 Determination on working time in
the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Determination of leave of absence
in the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Policy and procedures on incapacity
leave for ill-health retirement (PILIR)Pretoria National Office
De Wit P 2006 Reasons for absenteeism in the Department of Defence Pretoria Tshwane
University of Technology
Du Toit Damp Van Der Waldt G 1998 Public management grassroots Cape Town Juta
Du Toit D Knipe A Van Niekerk D Van Der Waldt Gamp Doyle M 2001Service
excellence in governance Cape Town Heinemann
Du Toit D Bosch D Woolfrey D Godfrey S Rossouw T Christie S Cooper C Giles
G amp Bosch C 2003Labour relations law a comprehensive guide4thedition Durban
LexisNexis Butterworths
Erasmus B Swanepoel B Schenk H Van der Westhuizen EJamp Wessels JS 2005 South
African human resource management for the public service Pretoria Juta
European Foundation for the Improvement of Living and Working Conditions
(EFILWC)1997Preventing absenteeism at the workplace Ireland Office for Official
Publication on the European Committee
Fakie SA 2005Report on the Auditor-General on a performance audit of the management
of sick leave benefits at certain national and provincial departments Pretoria Department
Public Service and Administration (DPSA)
Ferguson T D Muedder Kamp Fitzgerald R M2001 The case of total absence
management and integrated benefitsHuman Resource Planning24 (3)
Finnemore M amp Van Rensburg R 2002 Contemporary labour relations Johannesburg
LexisNexis
Gaudine A amp Gregory C2010The accuracy of nursesrsquo estimates of their absenteeism
Journal of Nursing Management 18599ndash605
Gauteng Province 2007 Human Resource Development Strategy for Gauteng for Gauteng
maximizing human capital for shared growth Pretoria Government Printers
76
Gauteng Province 20089 Annual report Pretoria Government Printers
Gauteng Province 2010 Monitoring and Evaluation Policy FrameworkGauteng Provincial
Government Office of the Premier
Ghauri P Gronhaug Kamp Kristianslund I 1995 Research methods in business studies
England Prentice-Hall
Goldsmith Mamp Morgan H 2003 ldquoLeadership is a contact sport The ldquofollow up factorrdquo in
management development The 5th Annual Global Learning SummitResearched and
organised by SALVO 20ndash24Feb
Goldstein M2008Why measure service delivery Are you being serviced New tools for
measuring service deliveryEdited byAmin S Das Jamp Goldstein MWashington DCThe
International Bank for Reconstruction and DevelopmentThe World Bank
Griep RH Rotenberg L Chor D Toivanen SampLandsbergis P2010Beyond simple
approaches to studying the association between work characteristics and absenteeism
Combining the DCS and ERI modelsRoutledge Taylor amp Francis GroupWork ampStress 24 (2
April-June)179ndash195Available athttpwwwinformaworldcom (Accessed on 20072011)
Grogan J 2003 Workplace law 7 th edition Lansdowne Juta
Grogan J 2005 Dismissal discrimination and unfair labour practices Lansdowne Juta
Hirschfield RR Schmitt LPamp Bedeian GA2002 Job-content perceptions performance-
reward expectancies and absenteeism among low-wage public-sector clerical employees
Journal of Business and Psychology 16(4) Human Sciences Press Available on
rhirschfterryugaed(Accessed on 30032009)
Hoxsey D2010Are happy employees healthy employees Researching the effects of
employee engagement on absenteeismCanadian Public Administration53 (4) p551-
571Canada The Institute of Public Administration of Canada
Jacobs EJamp Roodt G 2011 The mediating effect of knowledge sharing between
organisational culture and turnover intentions of professional nursesSouth African Journal
of Information Management
Jankowitz E 1991Terminating for absenteeism practical labour management Rivonia IR
Data Publication 1(10)
Keese M2006 Live longer work longerDELSA Newsletter OECD Available at
httpwwwoecdorgelsemployment(Accessed on 10072011)
77
Lambert EG Camp SD Edwards Camp Saylor WG 2005 Here today gone tomorrow
back again the next day absenteeism and its antecedents among Federal Correctional
staffWashington DC Ohio
Landstad B Vinberg S Ivergard TT Gelin G ampEkholm J2001Change in pattern of
absenteeism as a result of workplace intervention for personnel support Ergonomics
001401391544 (1)
LexisNexis 2006Labour Law Reports July 1994ndashDec2006CumulativeIndex Durban
LexisNexis
LexisNexis 2007 Legislation and strategyLexisNexis (9)Durban Butterworths Available at
httpwwwmylexisnexiscoza (Accessed on 15072011)
Madibana LF 2010 Factors influencing absenteeism amongst professional nurses in
London Pretoria University of South Africa
Markussen S Rogeberg OJ amp Gaure S 2009 The anatomy of absenteeism IZA
Discussion Paper Series No 4240 June Bonn Institute for the Study of Labor
McCormick ET amp Ilgen D1985 Industrial and organizational psychology 8th edition New
Jersey Prentice-Hall
McGoldrick E amp Arrowsmith JJ 2001Discrimination by age the organizational response
Ageism in work and employment Edited by Glover IampMohamed Sterling Management
SeriesEngland University of Sterling
Mellor N Arnold Jamp Gelade G2009The effects of transformational leadership on
employees in four of UK public sector organisations Health and Safety Laboratory for the
Health and Safety Executive UK RR648 Research Report
MINTRAC 2009 Literature review on labour turnover and retention Available at
strategieswwwmintraccom (Accessed on 14042009)
Mouton J2005How to succeed in your Masterrsquos and Doctoral studies a South African guide
and resource book Pretoria Van Schaik
Munro L 2007 Absenteeism and presenteeism possible causes and solutions The South
African Radiographer45(1) Available onhttpsorsaorgza(Accessed on 10072011)
Nel PS Gerber PD Van Dyk PS Haasbroek GD Schultz HB Sono TampWerner A
2001 Human resource management5th edition New York Oxford
Nel PS Kirsten M Swanepoel BJ Erasmus BJampPoisant P 2008South African
employment relations theory and practice6th edition Pretoria Van Schaik
78
Nichols AampEvangelisti W2001 Fitness for work the effect of aging and the benefits of
exerciseSterling management series ageism in work and employmentEdited by Glover
LampMohamed B England University of Sterling
Nyathi MN 2000Factors contributing to absenteeism among nurses a management
perspective Pretoria University of South Africa
Patrick MN 2001Positive psychological functioning among civil servantsPretoria
University of South Africa
Paton N2010 Long-term absence hand in hand Occupational Health Reed Business
Information UK Reed Elsevier Available athttpebscohostcomoasisunisaacza
(Accessed on 10072011)
Parbhoo S2003 Why worry about absenteeism in the workplace CCMA PublicationCCMA
Mail July
Pierce K2009 The impact of absenteeism in the public service in the context of GEMS
Pretoria GEMS Government Employees Medical Scheme [lsquoslrsquo]
Public Service and Co-ordinating Bargaining Council (PSCBC) 2000Resolution 72000
Polit DF amp Hungler BP 1995 Nursing research principles and methods Philadelphia
Lippincott
Pousette A amp Hanse JJ 2002Job characteristics as predictors of ill-health and sickness
absenteeism in different occupational types-a multigroup structural equation modelling
approachNational Institute for working life TaylorampFrancisSweden Goteborg Available on
httpwwwtandfcouk (Accessed on 10072011)
Public Service Commission2002Sick leave trends in the Public Service Pretoria Public
Service Commission
QUALSA Report 2009Policy procedure incapacity leave and ill-health retirement Steering
Committee QUALSA [rsquoslrsquo]
Reday-Mulvey G 2005Working beyond 60 key policies and practices in Europe New York
Palgrave Macmillan
Republic of South Africa 1995 Labour Relations Act 66 of 1995
Republic of South Africa 1997 Basic Conditions of Employment Act 75 of 1997
Republic of South Africa 2001 Public Service Regulation 2001
79
Republic of South Africa 2011 ldquoTowardsquality care for the patientrdquo National Core
Standards for Health Establishments in South Africa Pretoria Government Printers
Robbins SP amp Decenzo DA 2001 Fundamentals of management essential concepts and
applicationsNew Jersey Prentice Hall
Robbins SP Odendaal A amp Roodt G2004Organizationalbehaviour Global Southern
perspective 5th impression Cape Town Pearson
Rogers RE amp Hertin SR 1993Patterns of absenteeism among government employees
Public Personnel Management22 (2)Available at httpwwwquestiacom (Accessed on
10012009)
Serneels P Lindelow MampLievens T2008Qualitative research to prepare quantitative
analysis absenteeism among health workers in two African countriesAre you being
serviced New tools for measuring service deliveryEdited by Amin S Das
JampGoldsteinM2008 The International Bank for Reconstruction and DevelopmentThe
World Bank for Reconstruction and Development Washington D C The World Bank
Slabbert JA amp Swanepoel BJ 2001Introduction to employment relations
managementDurban Butterworths
South African Survey Millennium1999-2000 Johannesburg South African Institute of Race
Relations
Steers RMamp Rhodes SR 1978Major influences on employee attendance a process
model Journal of Applied Psychology63 (4)391-407
Oi-ling S2002Experience before and throughout the nursing careerPredictors of job
satisfaction and absenteeism in two samples of Hong Kong nursesJournal of Advanced
Nursing 40 (2)218ndash229 Available on httpwwwebscohostcomoasisunisaacza
(Accessed on 10072011)
Todd C2001Contract of employment Claremont Siber Ink
Tonya TW2001Minimizing absenteeism in the workplace strategies for nurse managers
Nursing Economics19 (2 MarApril) 53 3 Available at httpwwwoasisunisaacza
(Accessed on 14012009)
Tustin C 1994Industrial relations a psychological approach1st edition Halfway House
Southern Publishers
80
Unruh Jamp Strickland M2007 Nurse absenteeism and workload Negative effect on
restraint use incident reports and mortality JANORIGINAL RESEARCH Journal compilation
Florida Blackwell
Van der Westhuizen C 2006Work related attitudes as predictors of employee absenteeism
Pretoria University of South Africa
Venter R 2003 Labour relations in South AfricaRevised edition Cape Town Oxford
University Press
Viviane IJ 2011Absenteeism among women workers in industry85 IntrsquoLab Rev 248
(1962) Available at httpwwwHeinonlineorg(Accessed on 18052012)
Weeks KL 2004 Development and initial characteristics of a comprehensive survey on
workplace absenteeism Logan Utah State University Available on
httpwwwoasiscomunisaacza(Accessed on 14012009)
Welman JC amp Kruger SJ2001Research methodology for the business and administrative
sciences 2nd edition New York Oxford
Yende PM 2005 Utilising employee assistance programmes to reduce absenteeism in the
workplace JohannesburgUniversity of Johannesburg
81
ANNEXURES A B C
ANNEXURE A
PROCESS EVALUATION QUESTION COMPLIANCE
YESNO
ACTION PLAN
Retention and Reward -
leave
1 Are there complete and
accurate Z 1(Leave application
forms) forms on file
2 Have all application forms been
approved stamped and
registered
3 Have all forms been captured
on the Persal with the following
requirements
Supporting documents
A 10 day compulsory leave
processed within the annual
leave cycle Determination of
Leave
4 The remaining days are utilized
6 months from the end of the
leave cycle
5 Are there unutilized leave days
6 Has there been adequate
checking of leave reasons
Leave credits
Adherence to leave categories
(i)Normal ( ii) Incapacity
(iii) Injury on duty (iv) Maternity
(v)Adoption (vi) Family
responsibility
(vii) Office bearersshop stewards
and Casual Employees
7 Have work reasons been
provided for leave days
(Source Compiled by C S Ndhlovu 2012)
82
ANNEXURE B
Retention and
reward ndashsick leave
Evaluation Question Compliance YesNo Action Plan
1 Are there medical
certificates that have been
submitted to all medical
claims with the following
Specific illness stated
Supporting documents on
file
2 Has the 8 week rule for
36 days in a 3 year cycle
been adhered to
3 Are there complete
medical certificates for 3
days or more sick leave
days for normal sick leave
4 Are all other leave days
above 3 days utilized after
36 days treated as
temporary incapacity
leave
5 Are temporary
incapacity leave forms
submitted within 5 working
days after the first day of
absence
6Is there a register for
temporary incapacity
leave for 1 to 29 days lead
time for reporting leave
applications
7 Has the employer
approveddeclined the
leave application within 30
working days of receipt
(Source Compiled by C S Ndhlovu 2012)
83
ANNEXURE C
CHECK LIST
Is there a leave register in place for all leave applications
1 Is leave approved prior to the employee proceeding on leave
2 Area attendance registers maintained and up to date
3 Are periodic audits for leave carried out
4 Is there evidence of GSSCrsquos approval on leave applications
5 Are leave forms accurately captured on Persal
6 Are leave forms accurately completed by applicants
7 Is movement of leave forms monitored between the GSSC and institutions
8 How is rejected leave application dealt with
(Source Compiled by C S Ndhlovu 2012)
84
ABSTRACT
The research is a quantitative descriptive survey The sample is a stratified random sampling
of the workforce (n=4010) of the four hospitals in Gauteng that fall under the jurisdiction of
Tshwane Ekurhuleni and Johannesburg Metropolitan Councils The research examines the
extent of the impact of age gender occupation salary level tenure and race on workplace
absenteeism The data were collected in three phases involving auditing of hard copy files
structured interviews and information technology system
The findings of the research reflect high workplace absenteeism in females by 832 age
group between 45 to 49 years by 2235 salary range of 2 to 3 by 353 African race group
by 963 tenure of 11 to 20 years by 443 nurses by 208 and administration support by
354 The research found that the mature employee in age and of higher year of tenure
presented comparatively with lower rate of absenteeism
Key words
Workplace absenteeism workplace absenteeism employee abscondment and desertion
employment relationships leave cycle quality standard
III
ACKNOWLEDGEMENTS
This work is dedicated to my late son Neville Ndhlovu my loving husband Errol Ndhlovu
who has been my pillar of strength my son John Ndhlovu for the unwavering
encouragement throughout this tough journey my nuclear family without whose support
during the grieving period I would not have completed this research I would like to
acknowledge my daughter-in-law Vuyelwa Ndhlovu and my lovely grandchildren Nhlamulo
and Ntsako Ndhlovu who are the sunshine of my life who allowed me to work on
ldquoProfessorrsquos workrdquo as they referred to the research I thank God who made it possible for
me to stay on track during the darkest hour in my life
I wish to extend my sincere gratitude to Professor Pauw who believed in me my
supervisor Professor S B Kahn who remained a beacon of hope during the most trying time
in my life Professor S B Kahn and my joint supervisor Mr A Van Schalkwyk offered valuable
professional guidance that ensured that the research met the required academic standard
I wish to extend my sincere gratitude to Mrs Marti Gerber who dedicated herself editing
this document
I am aware that there are others who also assisted in different ways whom I might have
omitted to mention in my acknowledgement who made it possible for me to complete the
task at hand The quality of your efforts and assistance is evident in the final product May
God bless you all in your generous efforts towards completion of this research
IV
GLOSSARY
ANC = African National Congress
BCEA=Basic Conditions of Employment
CNA=Canadian Nurses Association
CAT= Catastrophic Model
CIPD= Charted Institute of Personnel Development
CCMA = Commission for Conciliation Mediation and Arbitration
CSRS=Civil Service Retirement System
DPSA=Department of Public Service and Administration
EAP= Employee Assistance Programme
EFILWC=European Foundation for the Improvement of Living and Working Conditions
FERS=Federal Employees Retirement System
GDoH=Gauteng Department of Health
GHP=Gross Health Product
HRIM=Human Resource Information Management
HRDS=Human Resource Development Strategy
RSA=Republic of South Africa
PILIR=Policy and Procedures on Incapacity Leave for Ill-Health Retirement
PERSAL= Personnel Remuneration Administration System
PSCBC=Public ServiceCo-ordinating Bargaining Council
PTO= Paid Time off Model
PSC= Public Service Commission
SACOB=South African Chamber of Business
V
Table of Contents
1 CHAPTER 1 GENERAL INTRODUCTION 1
11 INTRODUCTION 1
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH 1
13 PROBLEM STATEMENT 2
14 AIM AND OBJECTIVES OF THE RESEARCH 2
141 Aim 2
142 Objectives 2
15 LITERATURE REVIEW 3
16 TERMINOLOGY 3
17 RESEARCH DESIGN AND METHODOLOGY 4
171 Research design 4
172 Methodology 5
173 Unit of analysis 7
174 Unit of observation 7
18 CONSTRUCT VALIDITY 7
19 ETHICAL CONSIDERATION 7
110 LIMITATIONS OF THE RESEARCH 8
111 STRUCTURE OF THE RESEARCH 8
112 REFERENCE TECHNIQUEhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip9
113 CONCLUSION 9
2 CHAPTER 2 MANAGING ABSENTEEISM 10
21 INTRODUCTION 10
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM 10
221 Classification of absenteeism 15
222 Definition of key concepts 15
23 EMPLOYMENT RELATIONSHIPS 17
231 Employment relationship as a multi-dimensional phenomenon 17
2311 Economic dimensions 17
2312 Legal dimension 18
2313 Individual dimension 18
2314 Collective dimension 19
2315 Psycho-social dimension 19
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM 19
25 PREDICTORS OF ABSENTEEISM 20
26 A MULTI-GROUP INVARIANCE MODEL 22
27 CATASTROPHIC MODEL (CAT) 24
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM 24
VI
281 Measuring absenteeism 25
29 IMPACT OF WORKPLACE ABSENTEEISM 25
291 Cost to the institution 26
292 Low productivity 27
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM 27
2101 Effective communication 28
2102 Empowerment of managers 28
2103 Monitoring of workplace absenteeism 29
2104 Visits to facilities 30
2105 Incentive system 30
2106 Team support 31
2107 Return-to-work interviews 31
2108 Employee assistance programme (EAP) 32
2109 Occupational and safety committee 32
21010 Review committeehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip33
211 CONCLUSION 33
3 CHAPTER 3 METHODOLOGY IN RESEARCH 34
31 INTRODUCTION 34
32 RESEARCH DESIGN 34
321 Methodology 34
33 UNIT OF ANALYSIS 36
34 UNIT OF OBSERVATIONS 36
35 CONSTRUCT VALIDITY 36
36 ETHICAL CONSIDERATIONS 37
37 CONCLUSION 37
4 CHAPTER 4 INTERPRETATION AND ANALYSIS OF DATA 38
41 INTRODUCTION 38
42 THE STRUCTURE OF THE ORGANISATION 38
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY 39
44 COMPARISON OF HOSPITALS PERMANENT EMPLOYEES 40
441 The Tara Moross Centre Hospital 46
442 The Germiston Hospital 46
443 The ODI District Hospital 46
444 The George Mukhari Hospital 46
45 RESEARCH INTERPRETATION 47
451 Occupational groups in relation to absenteeism 49
4511 Doctors 50
4512 Professional nurses 51
4513 Staff nurses 51
VII
4514 Nursing assistants 51
4515 Finance officers 52
4516 Administration staff 52
4517 Administration support 52
452 Race in relation to absenteeism 57
4521 Africans 57
4522 Whites 57
4523 Coloureds 57
4524 Indians 58
453 Tenure range in relation to absenteeism 59
454 Salary range in relation to absenteeism 60
455 Age of full time employees in relation to absenteeism 61
456 Gender in relation to absenteeism 63
457 Week days in relation to occupational groups 64
46 CONCLUSION 66
5 CHAPTER 5 FINDINGS CONCLUSIONS AND RECOMMENDATIONS 67
51 INTRODUCTION 67
52 FINDINGS 67
53 CONCLUSIONS 71
54 RECOMMENDATIONS 72
BIBLIOGRAPHY 74
ANNEXURES A B Chelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip82
VIII
LIST OF FIGURES
FIGURE 21 CONCEPTUAL FRAMEWORK MODELhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
FIGURE 22 MODEL SPECIFICATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
FIGURE 41 INTEGRATED ORGANISATIONAL STRUCTUREhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip53
AS REPRESENTED BY THE HOSPITALS
FIGURE 44 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip58
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip60
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip61
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALShelliphelliphelliphelliphellip62
FIGURE 48 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip64
X
LIST OF TABLES
Table 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
Table 2 COMPARISONS OF NUMBERS OF ADMINISTRATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
AND SUPPORT STAFF IN THE DIFFERENT HOSPITALS
Table 3 GENDER COMPARISON IN DIFFERENT HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Table 4 COMPARISON OF TENURE OF SERVICE IN RELATION TOhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
ABSENTEEISM IN THE FOUR HOSPITALS
Table 5 COMPARISON OF THE OCCUPATIONAL GROUPShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip45
IN THE DIFFERENT HOSPITALS
Table 6 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip48
Table 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Table 8 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip54
(SALARY RANGE 1-12)
Table 9 AGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip55
Table 10 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Table 11 WEEK DAYS IN RELATION TO ABSENTEEISM INhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip65
THE FOUR HOSPITALS
Table 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphellip66
IX
CHAPTER 1
GENERAL INTRODUCTION
11 INTRODUCTION
The Gauteng Province is viewed as a province of opportunities by South Africans as well the
neighbouring countries such as Mozambique and Zimbabwe The impact of these
perceptions has placed a heavy demand on services including health provided within the
confines of the province the results being an increase in the workload of the employees
The indirect results of the increase in the workload have been unacceptably high levels of
absenteeism seemingly sub-standard levels of health care and high cost of delivering the
health care services Absenteeism poses a threat and can lead to the collapse of health care
services if absenteeism is poorly managed The research examines the management and
control of absenteeism in four out of thirty four hospitals that service the province The
hospitals that have been targeted for the research are ODI District Hospital Germiston
Hospital TARA Moross Centre Hospital and George Mukhari Hospital
This chapter explains the background and motivation for the research The research
highlights the problem statement which focuses on the effective management of
absenteeism The objectives of the study the research methodology and structure of the
research are explained The relevant literature review was consulted for the research The
key concepts that are used in the research are conceptually defined The research design is
a descriptive stratified random survey The data that were used were collected in three
phases the unit of analysis were the employees of the Gauteng Department of Health in the
four target hospitals and the unit of observations were observations of the employees of
the four hospitals The construct of validity was achieved through using a variety of data
collection methods Ethical considerations were taken into account during the research
process Limitations of the research were imposed by the uniqueness of each of the target
hospitals The structure of the research and the reference technique is explained in this
chapter The research on absenteeism in the Gauteng Department of Health is confined to
the period of 1 January 2008 to 31 December 2008 and focused on the working-man days
lost how absenteeism is managed and employee well-being and rehabilitation
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH
The Gauteng Department of Health received a qualified report in 2008 on the control of sick
leave A performance audit was conducted by the Public Service Commission (PSC) (2002
xvi) into the information required to effectively manage sick leave in the public service
1
The research on absenteeism in Gauteng Department of Health seeks to examine the extent
of workplace absenteeism in the ODI District Hospital which is in a transitional stage from
North West to the Gauteng Province The hospital falls under Tshwane Metropolitan
Municipality and is in Region C The Germiston Hospital falls under Ekurhuleni Metropolitan
Municipality in Region B TARA Moross Centre Hospital is in Region A under the
Johannesburg Metropolitan Municipality and George Mukhari Academic Hospital is Region C
under the Tshwane Metropolitan Municipality The research seeks to examine the degree of
compliance by the four hospitals with the recommendations of the performance audit of
management of sick leave in the light of the qualified report received by the Gauteng
Department of Health (Human Resources) in 20089
13 PROBLEM STATEMENT
The Gauteng Department of Health provides health care services as the core business of the
Department The Health care services are labour intensive and high levels of absenteeism by
its employees undermine the Departmental efforts to deliver quality health care to the
people of Gauteng The problem statement therefore is to examine to what extent the
effective management of absenteeism can enhance the effectiveness of the Gauteng
Department of Health
14 AIM AND OBJECTIVES OF THE RESEARCH
The aim and objectives of the research are explained in this section
141 AIM
The aim of the research is to determine how the effective management of absenteeism can
contribute to the effective health care of Gautengrsquos communities
142 Objectives
The objectives of the study are
to determine the impact of the variables such as age gender occupational category
and salary level on workplace absenteeism
to determine whether the correlation between absenteeism levels and tenure of
service does exist
to determine trends of workplace absenteeism in different employee categories and
to establish the different challenges confronting the different hospitals in
management and control of absenteeism in terms of size complexity and location
2
15 LITERATURE REVIEW
Various studies have been conducted to examine workplace absenteeism in different fields
in government and private institutions Van Der Westhuizen (200636) research focused on
high and low combinations of job involvement and organisational commitment The
outcome was not emphatic on the findings as predictors of the turnover and absenteeism
The research noted that women are more absent from the workplace than men De Wit
(2006) focused on the nature of absenteeism the impact of absenteeism on the
organisation reasons for and causes of absenteeism and measurement of absenteeism and
the findings were not able to find a high coefficient in the test sample
Camp and Lambert (20054) found that the use of sick leave as an incentive to reduce sick
leave by the employees under the Civil Service Retirement System (CSRS) led to a reduction
of absenteeism as a result of sick leave when compared with employees who functioned
under the conditions of the Federal Employees Retirement System (FERS) who within the
same company lost the unused sick leave when they retired
Ferguson Ferguson Muedder and Fitzgerald (200138) focused on the impact of
absenteeism and cost in terms of time lost in the Total Absence Management (TAM)
concept and found that the aging employee exposes institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods of
time
Serneels Lindelow and Lievens (2008210) claim absenteeism is high among employees in
the public sector in developing countries due to a lack of accountability and a lack of
punishment for transgression
The research seeks to determine the extent of the problem of workplace absenteeism its
impact and management in the identified hospitals It seeks to establish the relationship if
any between the various variables and absenteeism such as age occupation tenure salary
level gender and race
16 TERMINOLOGY
Key concepts that are used in the research are conceptually defined however a
comprehensive concept clarification will be done in chapter 2
Workplace absenteeism Workplace absenteeism is the absence of employee at the
workplace that is defined by Du Toit and Van Der Waldt in (1998139) as the place that the
institution makes available and where officials have to perform their work
3
Workplace forms part of the internal environment for public administration in the public
service Robbins Odendaal and Roodt (200415) define absenteeism as the failure of an
employee to report for work as scheduled regardless of the reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work According to
Venter (2003267) desertion occurs when the employee leaves the place of employment
without the intention to return to work
Employee An employee is defined as any person employed in terms of the Public Service
Act 1994 irrespective of rank or position (Public Service Act 1994 Subsection 15) Todd
(20011) refers to an employee as any person excluding an independent contractor who
works for another person and is entitled to be paid for it or who in any manner assists in
carrying on or conduct the business of the employer Bendix (2000123) defines an
employee as a person in a workplace except a ldquosenior managerial employeerdquo whose status
and contract of service grants the employee the authority to represent the employer in
interactions with the workplace forum to determine policy on behalf of the employer and
make decisions which might conflict with representation of workers at the workplace
Employer An employer as an individual person who may be the employer in legal terms as
well as the organisation which is responsible for implementing Public Service human
resource management policies (RSA 1997 Section 15)
Leave cycle The Public Service Act 1994 refers to the leave cycle as 36 months employment
with the same employer
Quality Is defined as getting the best results possible within the available resources (RSA
2011)
Standard Is a statement of an expected level of quality delivery A standard reflects the
ideal performance level of a health establishment in providing quality care (RSA 2011)
17 RESEARCH DESIGN AND METHODOLOGY
This section deals with the research design and methodology
171 Research design
Research design is the overall plan for relating the conceptual problem to relevant empirical
research It is a quantitative descriptive research that involves the systematic collection of
numerical information under conditions of considerable control (Polit amp Hungler 1994
24175)
4
The choice of the research design influences subsequent research activities such as
identifying the target subjects what data to collect and how they should be collected The
research design is a descriptive stratified random survey which is concerned with
characteristics of a specific population subject at a fixed point in time for comparative
purposes The focus is on a representative sample of the relevant population It is concerned
with the accuracy of the findings and their generalisability The survey is used to gain deeper
insight of the behaviour of employees with regards to motivation satisfaction and
grievances (Babbie 199289 Ghauri Gronhaug amp Kristianslund 199527 60 Brink 199611
6 Welman Kruger amp Mitchell 200152)
172 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services Four hospitals of the thirty four health care delivery institutions have been
identified for the research
Each hospital is unique in its character in terms of specialisation of health care delivery
service The four hospitals are located in Tshwane Johannesburg and Ekurhuleni
Metropolitan Municipalities The sample is a stratified random sampling which is composed
of various clearly recognisable non-overlapping sub-populations (strata) that differ from
one another mutually in terms of variables that are a combination of more than one
variable such as age sex income level or educational level The purpose is to ensure that
every part of the population (every stratum) is represented The members of a particular
stratum are homogeneous in the population at large The sample is representative of a
population with clearly distinguishable strata with a greater degree of certainty (Babbie
199267 Brynard amp Hanekom 200544 Ghauri et al 199578 Brink 1996138 Welman amp
Kruger 200155-56 Welman et al 201061 Polit and Hungler 199518) The data were
collected in three phases
The first phase of data collection was done through auditing of hard copies of identified
personnel files representing ten files per hospital and using the tool in annexure A amp B The
forty employeesrsquo profiles were accessed through the Human Resource Information
Management system (HRIM) located in the Gauteng Department of Health Head Office The
respective employeesrsquo profiles were handed over to the human resource manager in the
respective hospitals on the morning of the audit for the human resource practitioner to
draw out the hard copy files for auditing The characteristics of the individuals that were
identified for the first phase were males and females and the different race groups The
auditing of the files was for the complete working life of the employees and not confined to
2008 only Registers that are used by the human resource administration to control the
movement of the leave forms were inspected as evidence of the control system in place
5
The purpose of auditing the files is to gain insight into how leave in general was captured
managed and controlled by the hospitals The second phase of data collection was done
through structured interviews with the four human resource managers who were directly
accountable for management and control of leave of absence in general in the four
hospitals
A structured interview provides for a more organised approach and a more stable basis for
assessment of the different candidates (Erasmus Swanepoel Schenk Van der Westhuizen amp
Wessels 2005250) The structured interview was conducted using the tool in annexure C
Tara Moross Centre Hospital had been functioning without a manager in human resource
and the manager that was interviewed had been in the post for three months The human
resource practitioner who was at salary level 8 acting in the Assistant Directorrsquos post
(manager) was invited to join the manager and be part of the structured interview ODI
District Hospital had three human resource practitioners including the accounting officer at
level 8 and in an acting capacity
The third phase of data collection was through the Human Resource Information
Management (HRIM) This system used Personnel Remuneration Administration System
(PERSAL) to collect data Data in this system are categorised in salary level date of
appointment occupational category gender age in units of five race employing hospital
employment status in different categories such as session contract and full-time and the
different types of leave of absence
The research used primary and secondary data in analysing sick leave utilised by full time
employees in the identified hospitals for the period of 1 January to 31 December 2008 using
the Personnel Remuneration Administration System The total population sample was four
thousands and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range at level 1 to 12
The research used past events such as sick leave utilised by employees using secondary
data from Personnel Remuneration Administration System falling into the category of a
historical empirical research The interval scale of measurement was used in the
quantitative research and actual numbers are ordered with equal measurement between
each category (Brink 1996 149 Brynard amp Hanekom 2005 28-29 Mouton 2005
52100170)
6
173 Unit of analysis
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the research refers to observation of work attendance by
the employees of Gauteng Department of Health in the four hospitals
The observation deals with the historical events such as employees who have already
utilised sick leave in the workplace The subjects that are studied are the core health care
providers such as doctors nurses and support employees such as allied administration and
administration support (Mouton 200551-52 Welman et al 2001 52-53)
174 Unit of observations
The observations that are made are of health care workers and support teams in Tara
Hospital Germiston Hospital ODI Hospital and George Mukhari Hospitals The unit of
observations describes the characteristics of a large number of individual people such as
gender age salary range occupational category tenure of service and race in relation to
absenteeism in the workplace In the descriptive research the individual characteristics are
aggregated for the purpose of describing a larger group (Babbie 199292)
18 CONSTRUCT VALIDITY
Construct validity is concerned with the question what construct is the instrument actually
measuring(Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with the four accounting officers in leave management The third phase was collecting of
personnel data through the Persal system
19 ETHICAL CONSIDERATIONS
Ethical considerations included among other issues the protection of the unit of analysis and
unit of observations from discomfort and harm by not revealing information which can
cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity Anonymity is achieved
when the researcher cannot link a given response with a given respondent and reporting
aggregate data only When data are collected at one sitting and not over a period of time
makes it possible to achieve anonymity as the need for follow up is eliminated Subjects of
observations are selected for reasons directly related to the problem being studied as the
principle of justice
7
Confidentiality is about the researcherrsquos responsibility to protect all data gathered within
the scope of the research and shared only with people involved in the research (Babbie
1992465ndash466 Brink 199640ndash41 45)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous The interview was part of the actual audit
that was done as part of monitoring and evaluation that was in progress in the Department
of Health following a negative auditor generalrsquos report about management of leave in
general The managers were put at ease as they were given the check list afterwards for
self-monitoring for future self-auditing
The data that were collected through Personnel Remuneration Administration System
(Persal) identified employees through the Persal number and kept their identity anonymous
The data that were collected through the hard copy of employeesrsquo files were used to point
out areas of concern to the managers and the files did not leave the office of the manager
at the end of the process once more protecting the identity of the employee
110 LIMITATIONS OF THE RESEARCH
The research was conducted on four hospitals of different sizes specialisation and three
metropolitans with unique challenges The period of the research was confined to a
calendar year (2008) and not a financial year The focus was on absenteeism due to sick
leave of full time employees There is no distinction that is drawn between the working-man
days that are lost between shift and non-shift workers The findings may be different if all
absenteeism of employees at the time were considered for the research
111 STRUCTURE OF THE RESEARCH
Chapter 1 It provides a general introduction to the research It includes an introduction the
background and motivation for the research that provides the context the problem
statement and the significance of the research The key concepts are defined The research
design the method of data collection the sampling method data analysis and
interpretation limitations to the research are explained in this chapter
Chapter 2 This chapter considers the theoretical foundations concepts characteristics
theories approaches and classifications of workplace absenteeism Conceptual framework
of absenteeism predictors of absenteeism and various models of absenteeism are
explained Measures to control workplace absenteeism the impact of absenteeism in the
institution and management intervention strategies are explained
Chapter 3 It describes the research design different aspects of the research methods
applied and the data collection techniques used unit of analysis units of observations
construct validity and ethical considerations
8
Chapter 4 This chapter provides the organisational structure of the Gauteng Department of
Health comparisons of hospital employees different race groups of the four hospitals
gender comparisons in different hospitals and comparisons of the different occupational
groups It provides a short description of the target hospitals The research interpretation is
discussed in terms of the different occupational groups and absenteeism different races
and absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism
The week days absenteeism pattern and contributions by the four hospitals to absenteeism
are presented in this chapter
Chapter 5 It provides a discussion of the research evaluation of workplace absenteeism
findings recommendations and limitations
112 REFERENCE TECHNIQUE
The reference technique that is applied in the research involves all sources that have been
consulted while doing the research When legislation is used as a source of information
reference to the specific act is used
113 CONCLUSION
Chapter 1 provides a discussion on the background and motivation of the research problem
statement and the objectives The significance of the research in South African public
institutions and private institutions of other countries and the possible contribution of the
study are explored The terminology that is used in the research is contextualised for the
purpose of the research The research design and methodology are presented in this
chapter The units of analysis the units of observation construct validity ethical
considerations and limitations to the research are also presented in this chapter
The next chapter discusses the theories of absenteeism
9
CHAPTER 2
MANAGING ABSENTEEISM
21 INTRODUCTION
The Gauteng Department of Health is classified as a public institution whose existence is
justified on the grounds that it renders health care services to the public The health care
system is encouraged to develop delivery systems and practices that are in line with
international standards management practices that promote efficient and compassionate
delivery of services and ensures respect for human rights and accountability to the public
(African National Congress 199443-44) This objective can only be achieved if the resources
to provide such services are available The human resources are a vital factor for the health
care sector as it is labour intensive Public institutions such as the Gauteng Department of
Health are funded from public funds and if the human resources do not report for work
service delivery is compromised and the cost to the department in the form of salary
expenditure becomes exorbitant as the department must find replacement staff and pay
for overtime as well It is when all these factors are taken into consideration that workplace
absenteeism becomes a cause for concern for the Gauteng Department of Health
In this chapter absenteeism is discussed from a theoretical perspective and informed by
literature review The classification of workplace absenteeism theoretical perspective
definitions dimensions of employment relationship conceptual framework of absenteeism
structural model of absenteeism legislative framework that regulates the employment
relationship and intervention strategies to control workplace absenteeism are explored
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM
According to Viviane (20111) the term absenteeism was first used in Britain during the
First World War in dealing with employed persons It is during the times when production is
of pressing national importance that the absence of employees from the workplace is keenly
felt Absenteeism is considered a good barometer of staff morale an indirect measure of
employeesrsquo health and well-being and is found to be associated with health-related
absences from work Employees who are motivated and committed to their work and
employer have to be very sick before they book off sick (Griep Rotenberg Chor Toivanen amp
Landsbergis 2010179)
McCormick and Ilgen (198556-57) describe job attendance criteria as relating to a tendency
of employees to withdraw from or attend to their jobs The criteria identified were job
tenure occupational category absenteeism and tardiness According to Markussen
Rogeberg and Gaure (20096) employee characteristics such as age gender education and
occupation have a substantial impact on absence behaviour
10
Chaudhury and Hammer (20033) identified that medical skills and nursing skills are
marketable and greatly in demand Doctors and nurses used this opportunity to make
money and work as private health care providers as well as public health care providers
holding two jobs The absence is considered in terms of morning or afternoon absence by
these categories as they are viewed as having a great deal of discretion over where and
when to discharge their public responsibilities The criteria identified were job tenure
absenteeism and tardiness
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) refer to absenteeism
as non-attendance when an employee is scheduled to work The theoretical perspective of
absenteeism takes into account the physical and or psychological absence of the employee
from the workplace or work station at a time when the employee is contractually expected
to be at the workplace According to Andrews (199734-35) the behaviour and actions of
public officials are determined by specific ethical codes of conduct and it is assumed that
their actions are for the benefit of the communities that are serviced by the public officials
Social ethics focus on how the clients of the Department are treated and are therefore
concerned with the impact of decisions on people inside and outside the institution
individually and collectively
Grogan (2005237) states that employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
look for trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
2001 section F(c) In the public sector contractual employee benefits are modified by
collective agreements These benefits are material gains for the employees and have a
monetary value and a cost factor to the employer
The contract of employment often includes insured benefits such as incapacity ill health
and early retirement as the total package other than the remuneration for the time worked
as it is intended to attract retain and motivate employees (Breetzke 20091 Ferguson et al
200137 LexisNexis 2006670 LexisNexis 2007176 Markussen Rogeberg amp Gaure 20093
Tustin 199452) The policy on Determination on Leave of Absence requires a medical
certificate for sick leave of three or more days and for every sick leave day utilised when the
eight week rule has been transgressed (DPSA 2009 Section 14 subsection 147)
Political ideologies influence the work environment resulting in some areas being highly
unionised where unions are perceived to be capable of exerting control over the employer
and employee relations for the primary benefit of the employees
11
It is the work environment which is highly unionised that is characterised by high workplace
absenteeism (Andrews 199736 Breetzke 20091 Du Toit amp Van Der Waldt 1998170139
Tustin 199452) Allen (1984331) claims that union members might be absent more
frequently from the workplace than non-members because they face smaller penalties for
absenteeism According to Markussen et al (20095 21) workplace environments do have an
impact on absenteeism and are influenced by social interaction processes among
colleagues Absenteeism is affected by social norms Workplaces with high employee
turnover rate tend to have high absenteeism The turnover rate is defined on a quarterly
basis as Min (number of entries number of existing persons) divided by the number of
employees at the start of the quarter The Charted Institute of Personnel and Development
(CIPD) (200811) claim that the 2006 survey of absence management portrays the public
sector employees as less likely to be dismissed for reasons of workplace absenteeism A
report by the National Institute of Labour Studies (Tonya 20011) found the rate of
absenteeism increased among full-time employees from 2 4 to 25 within two years
The services that are provided by the Department of Health are divided into two distinct
categories Direct services are those services that are rendered to the clients who are
patients who receive medical treatment from the core employees usually referred to as line
functionaries Direct services can only become effective and efficient when supported by
the services of the support staff that provide indirect health care services When employees
do not present themselves for work when scheduled to work and do so on a regular basis
the situation becomes habitual absenteeism (Du Toit amp Van Der Waldt 199818) The
Gauteng Department of Healthrsquos core function is to provide health care services to the
people of Gauteng Province The provision of health care services is labour intensive and
requires large numbers of personnel for effective service delivery
The workplace which may be physical or virtual for the public service employees represent
the internal environment of the institution The employer who is represented by the
manager determines the workplace for employees
Rogers and Hertin (1993217) explain the Decision Model Theory as a conscious decision by
the employee to stay away from work or come to work based on which motivation is
stronger at that moment It is not based on the ability to come to work
Serneels et al (2008210) claim that absenteeism is rife in the public sector especially where
employees hold two jobs The actions of public officials in the performance of their duties
should be ethically justified as it impacts on the decisions of people within and without the
institution individually and collectively Tension and job insecurity in the workplace
manifests as absenteeism (Andrews 199733-137)
12
Frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased staff
morale and high cost to health care (Davey amp Cummings 2009312-313) It is suggested that
on average health care workers are likely to be absent from work as a result of illness or
injury rather than other occupations Dagmara (20002) states that absenteeism may be a
benchmark of what is happening in the hospital setting Absenteeism is defined as habitually
not coming to work when scheduled to It is an indicator of psychological medical or social
adjustment to work
Absenteeism is measured by frequency or duration of work-days missed Frequency
measures provide a reasonable index of voluntary absenteeism whereby each incidence or
episode of absence is counted regardless of the duration of absence It is defined as the
number of days absent over a given period of time Other measures used were total days
duration and percentage Duration measures provide an index of involuntary absenteeism
such as time lost index To assess absence duration the total number of days is tallied
regardless of the number of incidents (Davey amp Cummings 2009313) High workload is
identified as one of the factors that affect absenteeism rate among health care workers
(Oi-ling 20023)
Workplace absenteeism is costly for an institution in terms of lost working-man days hiring
of staff to close the shortage absent or sub-standard service delivery and poor quality of
services The total cost of employment risk approach is about the estimation of the possible
cost of any absent employee to an institution per hour The annual cost to the institutions
per employee is in terms of direct and indirect costs such as overtime low productivity and
a decline in morale among workers who are expected to cover for an absent employee
(Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
The public service employees enjoy security of tenure which may be a contributory factor
of absence from work without good cause This practice is fostered by the knowledge that
they cannot be easily dismissed from their jobs therefore have the belief it is right to stay
away from work Misuse of sick leave is considered to be an overriding problem in instances
where the employee does not uphold the standard of honesty and incorruptibility or these
values are not considered to be the corporate values and norms of the institution (Andrews
1997 221-222 MINTRAC 20093)
Bangali (20043-5) describes age function in the sociological theory as a natural
characteristic of human beings but also an integral aspect belonging to the structure of the
society The age definition in the labour market is influenced by the structural functionalism
The employees age is categorised in the workplace in terms of functions to be performed
be it physical or intellectual The age group of 35 years to 49 years old employees comprise
the largest age group in the labour market
13
The employees who are less than 20 years of age reflect the highest absenteeism rate while
employees above 50 years of age reflect a decrease in the absenteeism rate The
disadvantage of the older workers is that their disabilities last longer once they are injured
and are more likely to be absent as frequently and more likely to be injured than younger
workers Keese (20062) states that ageism is evident in the public service and describes the
age group 25 years to 49 years old as prime age Rogers and Hertin (1993219) found a
significant correlation between the use of sick leave and age Employees with advanced age
used comparatively more sick leave in comparison with the younger employees The
Canadian Nurses Association (20065) noted a reduction in workplace absenteeism rate
among nurses who are less than 45 years of age and an increase in the absenteeism rate
among nurses above 55 years of age
Camp and Lambert (20054) found that the use of sick leave retention as an incentive to
reduce use of sick leave by the employees under the Civil Service Retirement System (CSRS)
leads to a reduction of absenteeism as a result of sick leave compared to the Federal
Employees Retirement System (FERS) who within the same company lost the unused sick
leave when they retired The Employees Retirement System (FERS) applies the same
principle of handling sick leave as the Gauteng Department of Health in the sense that
unused sick leave is forfeited at the end of the three year cycle (DPSA 2009Section 14)
Unruh and Strickland (2007674) found that absenteeism from the workplace does
contribute to a vicious cycle of a negative work environment which leads to more
absenteeism and increased turnover Absenteeism has been found to be higher in
employees who are over 50 years of age and the phenomenon is attributed to age and
changing abilities that increase when work is performed on a full time basis Part-time
arrangements reduce absenteeism as well as the cost of paying for a senior employee even
if seniority is just in tenure Age has been linked to a negative turnover in an institution The
older employee is less likely to leave the organisation An institution is healthier for a spread
of ages Some organisations consider employees to be older in batches or cohorts of five
such as 40 years to 44 years up to 64 years (Nichols amp Evangelisti 2001285 McGoldrick amp
Arrowsmith 200184 MINTRAC 20093 Reday-Mulvey 200579-194)
MINTRAC (20094-8) states that gender moderates the age turnover relationship Women
are more likely to remain in their jobs the older they get than men do Turnover is
occasionally related or preceded by high workplace absenteeism The occupational category
is linked to skill levels and salary levels The lower skill employees are concentrated in the
lower skill occupations and easily replaceable
14
Hirschfield Schmitt and Bedeian (2002553) conducted a research on low-wage public
sector clerical employees and found that those employees who perceived limited
performance-reward expectancies were likely to be absent more often The link between
skilled employees and absenteeism suggested that employees may have utilised
absenteeism as a means of compensating for perceived workplace contributions not
extrinsically rewarded
According to Gaudine and Gregory (2010599) the Canadian Institute for Health Information
(2007) found that absenteeism was a problem among health care workers in comparison to
other employees in other sectors Unruh et al (2007673) found the combination of high
registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery Markussen et al (200921) claim that the type of occupation an
employee is engaged in has an impact on absenteeism
221 Classification of absenteeism
The employees of the Gauteng province and their attendance at work are the focal point of
the province in relation to service delivery that is customer focused Health care services are
labour intensive and require employees to be at work when scheduled to do so (Gauteng
Province 201015) Workplace absenteeism can present in different forms and levels as a
result of a combination of variables (Andrews 19975 Breetzke 20091) McCormick and
Ilgen (198557) and Davey and Cummings (2009313) classify absenteeism as voluntary
when the absence is based on the conscious decision by the health care giver to withhold
contractual services The absence is uncertified unauthorised and unexcused while
involuntary absenteeism occurs for reasons beyond the control of the health care giver
such as illness injury or family responsibility Employers are challenged with the task of
differentiating between the absence due to elective workplace absence and absence due to
illness incapacity The differentiation is based on whether the illness incapacity is validated
by a legitimate medical certificate in terms of the prescript of section 23 of the Basic
Conditions of Employment Act (BCEA) 75 of 1997 (RSA 1997)
222 Definition of key concepts
Concepts are defined for common understanding in the context of the study
Workplace absenteeism Workplace absenteeism is absence of the employee at the
workplace that is defined by Du Toit and Van Der Waldt (1998139) as the place that the
institution makes available and where officials have to perform their work It forms part of
the internal environment for public administration in the public service Bamford Klein and
Engelbrecht (199911) refer to absenteeism as employees taking time off that has not been
scheduled
15
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) claim that
absenteeism is non-attendance when an employee is scheduled to work The European
Foundation (199711) views absenteeism as temporary or permanent incapacity for work as
a result of sickness or infirmity According to Robbins Odendaal amp Roodt (200415)
absenteeism is a failure of an employee to report for work as scheduled regardless of the
reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work The employee
should actually intimate expressly or by implication the intention not to return to work
According to Venter (2003267) desertion occurs when the employee leaves the place of
employment without the intention to return to work
Employee The Basic Conditions of Employment Act no 75 of 1997 Section 1 (a) (RSA 1997)
and Todd (20011) refers to an employee as any person excluding an independent
contractor who works for another person and is entitled to be paid for it or who in any
manner assists in carrying on or conduct the business of the employer The courts use the
control test which identified employees on the basis that they were part of the employer
organisation Bendix (2000123) claims that an employee is a person in a workplace except a
senior managerial employee whose status and contract of service grants the employee the
authority to represent the employer in interactions with the workplace forum to determine
policy on behalf of the employer and make decisions which might conflict with
representation of employees at the workplace Du Toit Bosch Woolfrey Godfrey Rossouw
Christie Cooper Giles and Bosch (200368) state that an employee is a person who works
for a single employer in a permanent fulltime capacity is subject to the supervision of the
employer and receives regular monthly or weekly remuneration and is obliged during
working hours to place his or her productive capacity at the employerrsquos prescribed disposal
Employer
Bendix (2000129) defines an employer as any person except an independent contractor
working for another person or the State and who receives remuneration or any manner
assists in carrying out or conducting the business of an employer DPSA (PILIR) (20094)
states that an employer is the Head of Department or a designated office which will be
responsible for the handling and investigation of incapacity leave applications and ill- health
retirement applications
16
23 EMPLOYMENT RELATIONSHIPS
The employment relationship is about balancing the simultaneous convergent and divergent
interests of the employer and the employee in a regulated manner with the aim of getting
the work of the institution done According to Erasmus et al (2005442) an employment
relationship exists when an individual is employed by someone else to be available to work
for that person in exchange for some remuneration It is through this employment
relationship that reciprocal rights and obligations are created between the employer and
the employee The employment relationship is conflictual in nature (Andrews 199736) The
employees through this relationship are enabled to gain access to the rights and benefits
associated with their employment The Labour Relations Act no 66 of 1995 (RSA 1995)
regulates the management of the conflict in the employment relationship through dispute
resolution structures such as the Commission for Conciliation Mediation and Arbitration
(CCMA) Labour Court and Labour Appeal Court when internal processes fail to resolve the
conflict The employment relationship can be traditional or typical and terms and conditions
of service of employment are regulated by collective agreements This is a tacit
acknowledgement of the existence of a typical employment relation
231 Employment relationship as a multi-dimensional phenomenon
Industrial relations and human resource management are bound together by the
employment relationship through labour employer and industrial relation triangle The
employment relationship is characterised by various dimensions as is the case in a broader
society The dimensions are economic legal individual collective and psycho-social (Grogan
200347)
2311 Economic dimensions
The economic dimension arises through the provision of labour by the employee in the form
of skill knowledge energy abilities and productive time to the employer in exchange for
remuneration Barker (200779) states that a reduction in working hours increases the
hourly cost of production in a unit unless there is a commensurate increase in productivity
The economic dimension is highly regulated The contract of employment includes insured
benefits such as incapacity ill health and early retirement The tendering of services by the
employees is a prerequisite to the employeersquos right to claim remuneration (Grogan
200347) According to LexisNexis (2007176) and the Public Service Regulations 2001
Section E E1 the actual contractual benefits are modified by collective agreements in the
public service sector Employee benefits are material gains for employees that have
monetary value and are a cost factor to the employer The Public Service Regulation 2001
Section F (a) states that the Head of Department shall promote economic and efficient use
of resource to improve the functioning of the public service (RSA 2001)
17
According to Ferguson et al (200137) and Erasmus et al (2005380) employee benefits are
the total compensation package other than the pay for time worked offered to employees
either partially or completely funded by the employer contributions In 2006 about R19
billion was lost on account of absenteeism from sick leave (LexisNexis 2006670 Patrick
2001 17)
Employee benefits are intended to attract retain and motivate employees Some of the
benefits offered to employees are mandated by law such as minimum leave provision as
contained in the Basic Conditions of Employment Act 75 of 1997 and Resolution 72000 of
the Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
2312 Legal dimension
The Labour Relations Act 66 of 1995 Section 3 of Schedule 8 requires that while employees
should be protected from arbitrary action employers are entitled to satisfactory conduct
and work performance from their employees The legal framework provides for the
regulatory requirements for human resource management in the working environment
Grogan (200347) and Grogan (2005120) view the employment relationship as formalised
by a legally binding agreement which is the contract The contract is regulated by specific
laws and formal rules with all the inherent rights and responsibilities to the employer and
the employee In terms of the employment contract one of the responsibilities of the
employee is to render service to the employer at specified agreed upon time except where
the employer has authorised the absence of the employee from the workplace Employees
have a fundamental duty to render services and the employer has a right to expect the
employees to tender such services A basic element of the duty to render service is that the
employee must be at the workplace at the specified agreed upon times unless there is
adequate reason to be absent Bendix (2000120) states that a contract is subject to the
terms and conditions of collective agreements The contract is subject to automatic changes
whenever a new collective agreement is in place The contract and its inherent benefits are
breached by elective absence behaviour of the employee The legal dimension has an
impact on the individual dimension
2313 Individual dimension
The employee enters into a working contract with the employer on an individual basis The
contents of the contract are subject to the Basic Conditions of the Employment Act 75 of
1997 The terms and conditions of employment in the public service are subject to collective
bargaining and collective agreements which influence the employment contract in the
Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
18
The contract of employment is entered into between the employer and the employee under
the supervision of the employer and for remuneration purposes
2314 Collective dimension
According to Slabbert and Swanepoel (20017) the collective dimension of the employment
relationship refers to the organised group aspect of the employment relationship which is
between labour as a group and employers and or their representative public sector
institutions The collective dimension aspect of employment relationship pertains to
legislation relating to bargaining dispute resolution and industrial action
2315 Psycho-social dimension
The psycho-social dimension of the employment relationship represents the unexpressed
needs and expectations of the employer and employees It refers to behaviour in the public
sector institutions within the context of the collective dimension (Davey amp Cumming 2009
313 Erasmus et al (2005442) The Public Service Regulation 2001 Section B states that the
Head of Department shall determine the working time of employees and take into
consideration their personal circumstances which have a social dimension (RSA 2001)
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM
Davey and Cummings (2009322) amalgamated two theories to create a theoretical
framework with the premise that employee attendance is based on two factors the ability
to attend and motivation to attend The theoretical framework focuses on individual work
ethics demographics and from the work environment Some form of absenteeism may be
difficult to prove in a situation where the employer has two or more operational stations or
the employee occasionally operates from a virtual office The duty to render service is
breached by the employee when the employee is physically present and mentally absent as
would be the case of sleeping on duty Workplace absenteeism is multi-dimensional such as
changes in the work environment that overburden the coping mechanism As a result of this
approach a multi-dimensional framework of absenteeism clouds the causative factors of
absenteeism (Breetzke 20091 Patrick 200124 Tustin 199452)
19
FIGURE 21 CONCEPTUAL FRAMEWORK MODEL
(Adapted from Davey amp Cummings 2009320)
The conceptual model uses individual predictors of absenteeism such as age salary level
tenure race gender occupation educational level job satisfaction and organisational
commitment ability to attend and pressure to attend Organisational commitment is
described as having loyalty to the organisation identifying with its core values and
influences whether or not an employee feels it is appropriate to take unauthorised
unscheduled absences Group level absenteeism is not viewed as a predictor of individual
absenteeism (Davey amp Cummings 2009320 Lambert Camp Edward amp Saylor 20058-9)
25 PREDICTORS OF ABSENTEEISM
Oi-ling (20023-6) claims that in Hong Kong there were 47500 work days lost as a result of
employee sick leave in 1998 and suggests the examining of stress levels for nurses in
different cultures to enable a fuller understanding of the predictors of absenteeism as
different cultures accept some predictors and some reject the same reasons for illness
20
Personal characteristics
2Employee value Job
expectation
1Job situation scopejob level role
stress work amp group size leadership
style
4 Satisfaction
with job situation
3 Ability to attend Illness and accidents transport problems
6 Attendance motivation
7 Employee
attendance
5 Pressure to attend work
incentiveswork ethics
Education
salary
tenure age
gender race
Occupation
Lambert et al (20058) claim that organisational commitment job satisfaction job stress
health issues and personal characteristics correlate as regards employee absenteeism The
findings of the research by Van Der Westhuizen (2006136) focused on high and low
combination of job involvement and organisational commitment and the outcome was
emphatic on the turnover as predictor of absenteeism
According to Unruh and Strickland (2007674) absenteeism from the workplace contributes
to a vicious cycle of a negative work environment which leads to more absenteeism and
increased turnover McCormick and Ilgen (198556) describe turnover as dysfunctional
where an employee wishes to leave the institution and the employer prefers to retain the
individual and is functional where the employee wishes to leave the institution and the
employer accepts the termination of services by the employee
De Wit (2006) focused on attitudes towards job factors that had an influence on
absenteeism and was not able to find a high coefficient in the test sample McGoldrick and
Arrowsmith (20018) claim that an organisation is healthier for a spread of ages Ferguson et
al (200138) state that aging employees expose organisations to high levels of absenteeism
through higher probabilities of becoming disabled for longer periods
Oi-ling (20023-6) and Patrick (200124) found that gender and age among other predictors
of absenteeism have a significant influence on absenteeism Age was positively related to
well-being in managers and negatively related to absence frequency among hospital
employees Older employees were shown to have higher responsibility at work and utilised
minimal days for sick leave Female employees were observed to have utilised more
absences than males
Andrews (1997221-222) and MINTRAC (20093-8) state that gender moderates the age
turnover relationship Women are more likely to remain in their jobs the older they get than
men do Turnover is occasionally related or preceded by high workplace absenteeism The
occupational category is linked to skill levels and salary levels The lower skill employees are
concentrated in the lower skill occupations and easily replaceable Public service employees
enjoy security of tenure which maybe a contributory cause of absence from work without
good cause a practice that is encouraged by the knowledge that they cannot be easily
dismissed from their jobs therefore have the belief it is right to stay away from work
Rogers and Hertin (1993217-222) found a correlation between the use of sick leave and
age Employees with advanced age comparatively used more sick leave in comparison with
younger employees The level of education seems to have influenced the use of sick leave
where the lower level categories of employees were found to have a higher level of
absenteeism than higher educated individuals
21
Robbins et al (200447) state that married women employees have fewer absences and
undergo fewer job turnovers Rogers and Hertin (1993222) express tenure as work
experience in years that is viewed as a predictor of employee productivity where seniority
has been found to be inversely related to absenteeism in terms of frequency and total
number of work-man days lost The level of education was found to have an influence
where the lower category of employees was found to have higher levels of absenteeism
than higher educated employees Jacobs and Roodt (2011425) and Davey and Cummings
(2009320) state that an organisational culture in hospitals can contribute towards lower
turnover as the turnover rate is a predictor of absenteeism The process can be facilitated
by promoting knowledge sharing that can provide opportunities that may meet employee
expectations
Pousette and Hanse (2002229-231) suggest that theories that make predictions about
antecedents to ill health and sickness absence make the assumption that the relationships
are the same in different occupations Reduced job autonomy is suggested to be associated
with higher sickness absence The occupation specific model is used in order to identify the
variance in the patterns in terms of occupation-groups Davey and Cummings (2009320)
found that turnover was significantly related to absenteeism
Hirschfield et al (2002553) conducted a research on low-wage public sector clerical
employees and found that those employees who perceived limited performance-reward
expectancies were likely to be absent more often The link between skilled employees and
absenteeism suggested that employees may have utilised absenteeism as a means of
compensating for perceived workplace contributions not extrinsically rewarded Unruh et al
(2007674) found that absenteeism from the workplace does contribute to a vicious cycle of
a negative work environment which leads to more absenteeism and increased turnover
26 A MULTI-GROUP INVARIANCE MODEL
A multi-group invariance structural model represents different types of occupations such as
industrial blue-collar workers industrial collar workers elderly care workers and child
health care workers The focus of this model relates to the extent to which a model that is
assumed to include a general population also includes sub-populations such as different
occupational types The occupation specific model allows different relationships between
variables in different occupations The specific model approach allows for identification of
the most common reasons for absenteeism and early retirement in the workplace and was
successfully utilised in Sweden A common model proposes that absenteeism is a
behavioural response to dissatisfaction with the job (Pousette amp Hanse 2002230-244)
Nyathi (200059) found that professional nurses were absent from work because they
wanted to prolong their weekends
22
Davey and Cummings (2009313) argue that on average health care employees are more
likely to be absent from work as a result of illness or injury than other occupations Paton
(20104) acknowledges that line managers are the fundamental building blocks for reducing
absenteeism and must be provided with the tools to manage absence The absence rate at
3 is considered very high and must be vigorously and progressively managed
FIGURE 22 MODEL SPECIFICATION
(Adapted from Pousette amp Hanse 2002232)
Pousette and Hanse (2002232-245) make the assumption that low job autonomy and low
skill discretion deprive the employees of the opportunity to handle work obstacles and
regulate workload to a manageable level implying a negative relationship to workload has
an impact on absenteeism rate Patrick (200123-24) states that changes in the working
conditions overburden the coping mechanism Work-related stress can lead to deteriorating
physical and emotional well-being The work object is the distinguishing quality between
occupations in the different occupational groups whereby the blue-collar employee works
with things that are tangible such as materials and machines whereas the white-collar
employee is knowledge based employee who is working with data
23
Structural Model
W L Work load
I H Ill-Health
S A Sickness absenteeism
S D Skills discretion
(autonomy)
27 CATASTROPHIC MODEL (CAT)
According to Buschak Craven and Ledman (199628) the catastrophic model (CAT) caters for
major illness that keeps the employee away from work for extended periods of time This
model is similar to short and long term incapacity sick leave whereby the employee has
exhausted the normal sick leave of 36 days which is catered for by DPSA section 14 (RSA
2009)
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM
The general behaviour and actions of public officials are determined by specific ethical
codes of conduct and the unethical conduct results in effective administration and
unsatisfactory service delivery (Andrews 199733) Effective control of workplace
absenteeism requires an absenteeism policy to be in place management to establish the
magnitude and patterns of absenteeism and raise awareness about the consequences of
breaking these rules (Bamford Klein amp Engelbrecht 19992)
The Determination on Leave of Absence in the Public Service (DPSA 2009 section 14 141)
the Public Service Co-ordinating Bargaining Council Resolution (PSCBC 72000) Davey and
Cummings (2009313) and DPSA (PILIR) 2009 section 3 31 state that an employee is
entitled to 36 working days sick leave with full pay in a three year cycle with the same
employer Any unused leave credits shall lapse at the end of the three year cycle The
employee is expected to utilise and manage the normal leave circumspectly The employee
who chooses to utilise sick leave days must submit a medical certificate for every occasion
of three or more sick leave days utilised The medical certificate must be issued and signed
by a practitioner or persons who are registered with the Professional Councils established
by the Act of Parliament Incapacity leave is additional sick leave granted conditionally at the
employerrsquos discretion An employee who has exhausted the normal sick leave during the
prescribed sick leave cycle and who requires to be absent from work due to a temporary
incapacity may apply for temporary incapacity leave with full pay According to the Policy
and Procedures on Incapacity Leave for Ill-Health Retirement (PILIR) (DPSA 2009) an
employer is not required to pay an employee if the employee has been absent from work
for more than two consecutive days or more than two occasions during an eight week
period and on request does not produce a medical certificate
The Public Service Regulations 2001 F (c) holds the manager accountable when an
employee abuses sick leave (RSA 2001) According to Parbhoo (20036) and Nel et al
(2008145) the doctor patient confidentiality is not above reach to the employment
relationship by suggesting that the employer can question the authenticity or contents of
the medical certificate if there is sufficient reason to do so within the confines of
confidentiality
24
According to Breetzke (20092) South African employees are challenged by global trends to
seek mechanisms to deal with excessive absenteeism at the workplace The Charted
Institute of Personnel and Development (CIPD) (200811) claims that the 2006 survey
showed that public sector employees are less likely to be disciplined or dismissed for
reasons of workplace absenteeism
281 Measuring absenteeism
Measuring absenteeism in the workplace enables the employer to determine the extent and
nature of the problem Absenteeism is measured using two measures total time lost and
absence frequency Nel et al (2001584) In institutions total time lost is determined for
every group of employees and category of absence such as sick absence authorised and
unauthorised absence The recognised international norm is 3 Institutions challenged
whether to accept the international norm as the given or strive to bring workplace
absenteeism down in the interest of quality and quantity of service delivery The total time
lost index is calculated as the Total number of days lost due to absence over the period
multiplied by a thousand and divided by the average number of employees multiplied by a
thousand and divided by an average number of employees multiplied by total work-days
over the period (Amin Das amp Goldstein 20086 Breetzke 20094 Nel et al (2001584)
According to Nel et al (2001584) high workplace absenteeism rate is suggestive of incidence
that is of short duration and therefore more disruptive to the operational plans of an
institution as prior knowledge of pending workplace absenteeism allows for forward
planning and reduction of the costs associated with absenteeism The absence frequency
rate is calculated as Number of absence incidence over the period divided by the average
number of employees employed over the period (Breetzke 20094 Nel et al 2001254)
29 IMPACT OF WORKPLACE ABSENTEEISM
Lambert et al (20056 36) claim that absenteeism has adverse effects on those employees
who are good attenders as they are shuffled around to fill in the positions of absent
employees Organisations suffer the detrimental effects and consequences of employee
absenteeism Management expend valuable time to modify employee assignments to
respond to absences When employees who are in management or in highly specialised job
assignments report sick the work assigned to them remains undone because their positions
remain vacated and the work remains for them to complete The responsibility and
accountability these employees are entrusted with may influence less use of sick leave by
them
The White Paper on Transforming Public Service Delivery (DPSA 1997) holds management
responsible for the specific level of resources and for obtaining value for money in these
resources
25
Madibana (201022) found in the research about absenteeism amongst nurses that the high
rate of absence had an impact in the reduction of quality care rendered by nurses
291 Cost to the institution
Andrews (19978221) describes an institution as the process through which activities are
grouped logically into the distinct areas and assigned to managers It results in the logical
grouping of activities in a department Workplace absenteeism influences the cost of an
institution which influences the quality of the product or service that is rendered by the
institution Employee attendance is a vital element for managing productivity of any
institution and its individual members The unfilled posts reflect the absence of public
health care employees and do not absorb budget resources for salary and upkeep of
facilities Absent personnel still receive their salaries If public servants are not on the job
the expenditures embodied in them do not reach their beneficiaries (Chaudhury amp Hammer
20032 Lambert et al 20055) The cost is direct in terms of salary expenditure or indirect in
terms of staff replacement
Ferguson et al (200138) argue that the cost of employment risk approach is about
estimation of the possible cost of any absent employee to an institution per hour per day
Robbins Odendaal and Roodt (200415) estimate that absenteeism costs South African
institutions millions of rand a year in decreased efficiency and increased benefit payments
Fakie (20053) notes that sick leave costs the national government 15 of the total basic
salary expenditure for the National Department of Health from 1 January 2001 to December
31 2003
The South African Chamber of Business (SACOB) (Patrick 200117) acknowledges that in
2006 about R19 billion were lost on account of absenteeism resulting from sick leave
According to the European Foundation (19977) United Kingdom lost 11 billion pounds in
1994 Germany lost 30 5 billion EUC in 1993 and Belgium lost 24 billion EUC in 1995
Breetzke (20092) describes indirect costs as hidden costs harder to measure and may
include economic value of lost productivity Indirect costs relate to loss of production that
may arise by engaging some expects to provide service in the field where they are closing
the staff shortage gap Rogers and Hertin (19939) and the European Foundation (19978)
view the individual employee and his or her dependants in a social dimension aspect as
exposed to reduced income as a result of extended workplace absenteeism related to ill
health where long term incapacity is involved
The total cost of employment risk approach is about estimation of the possible cost of any
absent employee to an institution per hour The cost may be direct and indirect such as
overtime low productivity and a decline in morale among workers who are expected to
cover for an absent employee (Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
26
292 Low productivity
According to Jankowitz (19911) high levels of absenteeism are disruptive to production
where operators are interdependent or where levels of service have to be maintained
Buschak Craven and Ledman (199626) argue that absenteeism generates costs for the
institution and productivity problems put an unreasonable burden on the rest of the
employees who are at work An absent employee be it physical or psychological remains an
unproductive employee Absenteeism viewed from an employerrsquos perspective is regarded as
a problem that impacts negatively on service delivery while the employeesrsquo believe their
mere presence in the workplace is being productive
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM
Managing workplace absenteeism remains a challenge for all employers and the Gauteng
Department of Health has not been spared the challenges faced by other institutions as it
provides health care services to the citizens of Gauteng The provision of good quality health
care is vital for the development of human capital The implications of declining quantity
and quality of care is grave when the human capital equity and efficiency which are the
cornerstones of health care service delivery are threatened by employees who are not at
work when expected to be (Gauteng Province 200711) Misuse of sick leave is considered to
be an overriding problem in instances where the employee does not uphold the standard of
honesty and incorruptibility or these values are not considered to be the corporate values of
the institution (Andrews 1997 221-222 MINTRAC 20093)
According to Grogan (2005237) employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
identify trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
Part V Section F(c) (RSA 2001) The workplace can be a virtual office Workplace
absenteeism is perceived to be high in unionised workplace environments where unions are
perceived to be capable of exerting control over the employer and employee relations for
the primary benefit of the employees In the public sector contractual employee benefits
are modified by collective agreements
Public service managers are to focus towards results achievement and be accountable for
the performance of their institutions (Gauteng Province 201023) Workplace absenteeism
can be reduced by tightening up policies and procedures relating to control of absenteeism
and intensifying monitoring processes on absent employees
27
According to Cloete (2004290-297) public institutions are to provide quality goods and
services The public institutions require an appropriate infrastructure to enable them to
perform their core functions (Bamford et al 19991 Buschak et al 1996 28 Munro
200722)
2101 Effective communication
According to Oi-ling (200212) managers should alter the psycho-social environment at work
and cultivate an institutional climate that supports staff and facilitate effective
communication Institutions should raise awareness to employees of their rights and
responsibilities regarding leave of absence and the consequences of abusing it (Bamford et
al 19992) The policies should be clearly written and well communicated to all employees
and be readily available and accessible In a highly unionised environment these policies are
debated in bilateral or multi-lateral forums between management or employer
representatives and labour representatives The human resource practitioners must conduct
periodic in-house training on these policies for management and employees to facilitate
uniform interpretation and enforce compliance by all stakeholders The policies must be
couched in simple understandable language that is free of legal terms for ease of
comprehension by all users The policies on workplace absenteeism must be explicit of
actions to be taken when policies have been violated or employees are aggrieved
2102 Empowerment of managers
Workplace absenteeism is multi-dimensional requiring inputs from all related fields
Managers require on-going support and training on issues that relate to absenteeism at the
workplace The human resource unit works with managers to establish performance
standards training of employees on the importance of execution and assists managers to
focus on continuous improvements superior execution and employee empowerment
(Bergdahl 20019 RSA 2011)
The labour relations unit supports the training of managers on grievance handling bilateral
and multi-lateral encounters with employee representatives with employee education
issues specific to workplace absenteeism The Charted Institute of Personnel and
Development (CIPD) (200835) reported that 70 of managers in the public service have
been trained in workplace absenteeism handling
Employment relationships bind human resource and industrial relations together with the
common objective of achieving institutional goals and labour peace Managers focus on
managing the institution for productivity at the lowest possible cost by providing quality
care therefore reducing the risk of litigation control of absence from work and work
efficiency
28
It is the delays in dealing with issues that give the employees the feeling of being unfairly
treated and demoralised Consistency in upholding these processes is essential for creation
of a stable employment relationship while any deviation from the set processes give rise to
worker unfriendly environment (Bergdahl 20118-9)
2103 Monitoring of workplace absenteeism
The manager is expected to keep accurate records for all leave of absence taken by
employees In terms of the management of ill-health absencersquos the manager has to ensure
that the eight week rule is observed whereby the employee who has been absent from
work on more than two occasions during an eight- week period must regardless of the
duration of the sickness or injury submit a medical certificate (RSA Part V section F (b)
DPSA 2009 section 14 148) Pierce (200921) believes that management of human capital
may be achieved through the integration of employee benefits employee assistance
programmes and human capital
Monitoring of absenteeism is a human resource function that gets lost in the competing
functions that are carried out by human resource practitioners High levels of absenteeism
are an indication of poor management and or conflict within the employment relationship
The methods to monitor workplace absenteeism vary from one institution to the other It is
human resource management that establishes common guidelines that are used by
management to monitor workplace absenteeism In monitoring absenteeism the manager
considers each employeersquos case on its merit
The manager focuses on certain aspects of the case such as failure to call in on the day of
absence pattern of use of sick leave before or after holidays and sick absence occurring on
certain days of the week or month Monitoring systems to monitor and record attendance
of work are put in place to assist management with simple accurate functional data that
facilitates informed decision- taking at management level The employees of the province
and their attendance at work become the focal point of the province in relation to service
delivery Peer pressure monitoring comes from colleagues at the same facility Hierarchical
monitoring of employees by management may lead to more attendance for fear of being
discovered (Chaudhury amp Hammer 200319 Gauteng Province 201015) A health care
service institution may use Health Information System and Personnel and Salary
Administration System (PERSAL) among others to ease the burden of the monitoring
process All these tools combined are useful in gathering administrative data for
management
29
2104 Visits to facilities
The role of human resource at institutional level is to support and guide management as
well as monitor compliance issues Workplace absenteeism remains a key focus area
because of its impact on the budget of an organisation Unscheduled facility visits are
conducted with the view to audit workplace absenteeism The audit is to be done in line
with the auditor-general or internal risk managementrsquos approach to encourage consistency
A check list that is used is prepared by human resource practitioners and institutions are
familiar with A human resource accounting officer of the institution should be involved
when an audit is done
The institution must have evidence available of sporadic visits to employees who have been
identified as having developed absenteeism patterns with the view to rule out elective
absence The European Foundation (199713) and Munro (200722) state that ill- health is
the main reason for workplace absenteeism Employees who present with ill- health are
generally and frequently more absent from work than the healthy ones The authors also
observe that not all employee assistance programmes aimed at reducing workplace
absenteeism have an effect on the ill-health of the employees which render the
unscheduled visit to the employees vital to see where the caring employer could be of
assistance
2105 Incentive system
According to Buschak et al (199628) the catastrophic model (CAT) caters for major illness
that keeps the employee away from work for extended periods of time This model is similar
to short and long term incapacity sick leave which is catered for by PILIR subsection 73
(DPSA 2009) The managers require special training for successful implementation of the
policy The paid time off model (PTO) has hidden benefits incentives for employees not to
use unnecessary sick days which are then paid for at retirement The research by Lambert
and Camp (20054) compares the Civil Service Retirement System (CSRS) and the Federal
Employees Retirement System (FERS) and showed that in the final analysis and when
novelty wore off workplace absenteeism was not necessarily reduced by the incentive
system
Management should use the strategy to raise awareness about responsible utilisation of sick
leave through workshops about PILIR and the eight week rule It should show the benefits
of good sick leave management when employees are challenged with temporary or
permanent incapacity leave
The use it or lose it approach of the current system reward the abuse of sick leave as it is
viewed as not being beneficial by the employees to act responsible towards the use of sick
leave There is no deterrent not to abuse sick leave in the public sector
30
2106 Team support
Institutions value team effort over individual achievement Operational competencies are
viewed as essential Managers encourage effective communication among team members
motivating others and the development of problem-solving skills Managers through the
team development effort encourage nurturing and transmitting of the institutional culture
Institutional culture refers to a system of shared meaning within an organisation that
determines how employees behave in the workplace Culture and people are like glue that
ensures that institutional standards are upheld Individuals become units that form the
team and conversations at work are encouraged to strengthen team work knowledge
transfer and productivity (Bergdahl 20018-10 Goldsmith amp Morgan 200378 Robbins amp
Decenzo 2001174)
2107 Return-to-work interviews
According to Paton (20101ndash5) a phased return-to-work data management and remote
services are among the approaches employers may use to manage workplace absenteeism
The intervention can involve use of Information Technology systems and telephone
discussions Good absence management is about good people management The return-to-
work interviews provide management with the opportunity to get to know the employee
better and for the employee to substantiate his or her case The employee is afforded
privacy during the sessions which should happen as soon as the employee comes back to
work The key success in this strategy is unthreatening follow ups that are done A multi-
faceted approach is used to get people back to work such as phoning maintaining regular
contact and taking medical advice
The Charted Institute of Personnel Development Annual Report (200835) reported 90 of
public services that use the strategy and 77 use the risk assessment to aid return- to-
work The manager should have private counselling sessions with the employee as soon as
the employee returns to work These sessions provide the employee with the opportunity to
put his or her case across and for the employer to get a first-hand opportunity to asses if the
employee is fit enough to come back to work The employer has to make the employee
aware of the status of the meeting that it is formal and proceedings are recorded The
employer is to keep accurate records of all counselling sessions
31
2108 Employee assistance programme (EAP)
DPSA (PILIR2009) prescribes that the PILIR committee promotes EAP in the workplace and
each institution to establish a committee The PILIR committee consists of a labour relations
officer an EAP practitioner a health practitioner an employee wellness practitioner and
any other relevant practitioner who is co-opted on a needs basis The purpose of the
committee is to manage short and long term incapacity which is sick leave utilised after the
employee has exhausted the 36 days normal sick leave in a three year cycle The short term
incapacity sick leave is of longer than three days and less than 29 days and long term
incapacity is sick leave longer than 29 days The short spells of sick leave become a concern
when there is evidence of a pattern of abuse It is a call for the manager to intervene Every
organisation should provide EAP that is funded by the employer to the employees A health
risk manager is used by the employees who are expected to honour referrals and stay with
the programme until such time that there is evidence of recovery failure by the employee
to accept the programme should attract a disciplinary process
According to Mellor Arnold and Gelade (20098) the amount of support that followers
receive from their transformational leader or co-worker may help reduce levels of absence
by making the workplace a more pleasant place to be and perhaps by helping the person
find solutions to work out family conflict or other problems that produce absence Landstad
et al (20011) suggest that the individuals in the preventive intervention group who were
less than 42 years of age total absence due to sickness decreased The change was obvious
to the cleaners who had a previous history of high absence due to sickness The Charted
Institute of Personnel Development (200836) focused on working-man days lost
management of absenteeism employee well-being and employee rehabilitation The skilled
employees were reported as 12 who were using rehabilitation programmes Yende
(200535) and Fakie (200517) state that EAP despite having been around since 1996 for the
National Department of Health has not actually been managed and utilised to its full extent
whereby if fully utilised would assist in the management of employee workplace
absenteeism
2109 Occupational and safety committee
The focus of this committee is on the provision of a safe working environment by the
employer (RSA Part VI section D 2001) It monitors issues of compliance and adopts the
employee advocacy role The committee consists of all the major stakeholders such as
employee representatives labour representatives that represent employees in the
institution on issues of safety at the workplace In the context of the Gauteng Department
of Health the committee engages with the labour representatives and employer
representatives at bilateral and provincial multi-lateral scheduled meetings
32
According to Du Toit and Van Der Waldt (1998139) the International Labour Organisation
recommends creation and maintaining of a pleasant work environment in order to improve
productivity The environment must stimulate the employee to ensure efficiency and
effectiveness
21010 Review committee
This structure is essential when dealing with incapacity leave It is composed of
management human resource practitioner employee representative labour relations
officer employee wellness and any adhoc person needed in terms of the case under
discussion (DPSA PILIR 2009) The employee reserves the right to lodge a grievance about
the outcome of his incapacity request if it is negative The role of the committee is to
provide a transparent forum reduce hostility against management and to protect the rights
of the employee through involvement of the employee representative
211 CONCLUSION
The literature review that has been consulted explores the workplace absenteeism and its
impact on the institution The employment relationships represent a triangle that consists of
the employer the employee and the industrial environment The relationship is multi-
dimensional and highly regulated with built in mechanisms to handle conflict in the
workplace Conflict is inherent to the employment relationship and structures and
mechanisms such as bargaining councils the Commission for Conciliation Mediation and
Arbitration and Labour Courts are structures for recourse The theory of absenteeism and
employment relationship were explored Management intervention strategies were
explained Controlling absenteeism in the workplace begins with a sound absenteeism
policy that is incorporated into an employee induction programme Communicating and
educating the employees about the absenteeism policy takes the centre stage in the
employment relationship Vigilant monitoring of workplace absenteeism is the responsibility
of the manager closest to the employee such as the supervisor Workplace attendance
problems of employees can be handled using sound judgement keeping accurate
attendance records and administering the policy fairly and consistently
Chapter 3 will collect data which will confirm or negate the literature review that has been
explored in chapter 2
33
CHAPTER 3
METHODOLOGY OF THE RESEARCH
31 INTRODUCTION
Chapter 3 focuses on the methodology used to determine the absenteeism in the four
hospitals of the Gauteng Department of Health The research design and the methodology
that have been used to collect data are discussed below The data are collected in terms of
the characteristics of the stratified random sample such as absenteeism of the different
occupational categories gender age tenure of service race groups and salary
32 RESEARCH DESIGN
A research design is the overall plan for relating the conceptual problem to relevant
empirical research It is a quantitative descriptive research that involves the systematic
collection of numerical information under conditions of considerable control The choice of
the research design influences subsequent research activities such as identifying the target
subjects what data to collect and how they should be collected The research design is a
descriptive survey which is concerned with characteristics of a specific population subject at
a fixed point in time for comparative purposes The focus is on a representative sample of
the relevant population It is concerned with the accuracy of the findings and their
generalisability The survey is used to understand the behaviour of employees with regards
to motivation satisfaction and grievances (Babbie 1992 89 Ghauri et al 199527 60 Brink
199611 Welman et al 200152)
321 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services The four hospitals that have been targeted for the study of absenteeism are Tara
Moross Centre Hospital in Region A under the Johannesburg Metropolitan Municipality
Germiston Regional Hospital which is in Region B under Ekurhuleni Metropolitan
Municipality ODI District Hospital in Region C under Tshwane Metropolitan Municipality
and George Mukhari Academic Hospital in Region C under Tshwane Metropolitan
Municipality Each hospital is unique in its character in terms of specialisation of health care
delivery service The sample is a stratified random sampling which is composed of various
clearly recognisable non-overlapping sub-populations (strata) that differ from one another
in terms of variables that are a combination of more than one variable such as age sex
income level or educational level The purpose is to ensure that every part of the population
(every stratum) is represented The members of a particular stratum are homogeneous with
the population at large
34
The sample is representative of a population with clearly distinguishable strata with a
greater degree of certainty (Babbie 19927 Brink 1996138 Brynard amp Hanekom 2005 44
Ghauri et al 199578 Welman amp Kruger 200155-56 Polit amp Hungler 199518)
The data were collected in three phases The first phase of data collection was done through
auditing of hard copies of identified personnel files encomprising ten files per hospital and
using the tools in annexure A and B The forty employeesrsquo profiles were accessed through
the Human Resource Information System (HRIM) located in the Gauteng Department of
Health Head Office The respective employeesrsquo profiles were handed over to the human
resource manager in the respective hospital on the morning of the audit for the human
resource practitioner to draw out the hard copy files for auditing The characteristics of the
individuals that were identified for the first phase were males and females as well as
representatives from the different race groups The auditing of the files were for the
complete working life of the employees and not only confined to 2008 calendar year
Registers that are used by human resource administration to control the movement of the
leave form were inspected as evidence of the control system in place The purpose of
auditing the files was to gain insight into how leave in general was captured managed and
controlled by the hospitals
The second phase of data collection were done through structured interviews with four
human resource managers who were directly accountable for management and control of
leave of absence in general in the four hospitals A structured interview provides for a more
organised approach and a more stable basis for assessment of the different candidates
(Erasmus et al 2005250) The structured interview was conducted using the tool in
annexure C Tara Moross Centre Hospital had been functioning without a human resource
manager and the manager that was interviewed had been in the post for three months The
human resource practitioner who was at salary level 8 and acting in the Assistant Directorrsquos
post (manager level 9) was invited to join the manager and be part of the structured
interview ODI District Hospital had three human resource practitioners including the
accounting officer at level 8 in an acting capacity The third phase of data collection was
through the Human Resource Information Management System (HRIM) This system uses
the Personnel Remuneration Administration System (PERSAL) to collect data Data in this
system is categorised in characteristics such as salary level date of appointment
occupational category gender age in units of five race employing hospital employment
status in different sub-categories such as session contract and full-time and the different
types of leave of absence The continuous sick leave of four to five days was excluded from
processing and focus was laid on sporadic days to the start and end of a weekend
35
The research used secondary data in analysing sick leave utilised by full time employees in
the identified hospitals for the period of 1 January to 31 December of 2008 using Persal The
total population sample was four thousand and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range from level 1 to
12 The research used past events such as sick leave utilised by employees using secondary
data from Persal falling into the category of historical empirical study The interval scale of
measurement was used in the quantitative research and actual numbers are ordered with
equal measurement between each category (Brink 1996 149 Brynard amp Hanekom 200528-
29 Mouton 200552100170)
33 UNIT OF ANALYSIS
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the study refers to observation of work attendance by the
employees of Gauteng Department of Health in the four hospitals The observation deals
with the historical events as employees have already utilised the sick leave in the workplace
The subjects that are studied are the core health care providers such as doctors nurses and
support employees such as allied administration and administration support (Mouton 2005
51-52 Welman et al 2001 52-53)
34 UNIT OF OBSERVATIONS
The observations that are made are of health care employees and support teams in Tara
Moross Centre Hospital Germiston Hospital ODI Hospital and George Mukhari Hospital
and describe the characteristics of a large number of individual people such as sex age
salary range occupational category tenure of service and race in relation to absenteeism in
the workplace The descriptive study and the individual characteristics are aggregated for
the purpose of describing a larger group (Babbie 199292)
35 CONSTRUCT VALIDITY
Construct validity is concerned with the question What construct is the instrument actually
measuring (Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with four of the accounting officers in the leave managements The third phase was
collecting of personnel data through the Persal system
36
36 ETHICAL CONSIDERATIONS
Ethical considerations will include amongst other issues such as the protection of the units
of analysis and units of observations from discomfort and harm by not revealing
information which can cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity
Anonymity is achieved when the researcher cannot link a given response with a given
respondent and reporting aggregate data only When data are collected at one sitting and
not over a period of time makes it possible to achieve anonymity as the need for follow up is
eliminated Subjects of observations are selected for reasons directly related to the problem
being studied as the principle of justice Confidentiality is about the researcherrsquos
responsibility to protect all data gathered within the scope of the study and shared only
with people involved in the research (Babbie 1992465ndash466 Brink 199640ndash41 45 Polit amp
Hungler 1995 31-36)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous to the researcher The interview was part
of the actual audit that was done as part of monitoring and evaluation that was in progress
in the Department of Health following a negative auditor generalrsquos report about
management of leave in general The managers were put at ease as they were given the
checklist afterwards for self-monitoring and for future self-auditing
The data that were collected through Persal identified employees through the Persal
number and kept their identities anonymous The data that were collected through the hard
copy of employeesrsquo files were used to point out areas of concern to the managers and the
files did not leave the office of the manager at the end of the process once more protecting
the identity of the employee
37 CONCLUSION
This chapter dealt with the research design which is the overall plan for relating the
conceptual problem to relevant empirical research The methodology used a stratified
random sample which is composed of various clearly recognisable non-overlapping sub-
populations that differ from one another in terms of variables that are a combination of
more than one variable The data collection was done through three phases The unit of
analysis refers to the persons who are studied The unit of observations are health care
workers and support teams in the four identified hospitals The construct validity used a
multi-trait multi-method approach Ethical considerations include among other issues
protection of the unit of analysis and the unit of observations from discomfort and harm
Chapter 4 discusses the analysis and interpretation of the data gathered in chapter 3
37
CHAPTER 4
INTERPRETATION AND ANALYSIS OF DATA
41 INTRODUCTION
This chapter focuses on the research analysis and interpretation of data gathered on
workplace absenteeism in the Department of Health of the Gauteng Province It seeks to
identify differences or similarities in the leave trends in the 2008 calendar year between the
four identified hospitals chosen for the study in the Municipality of Tshwane Ekurhuleni and
Johannesburg The year 2008 was chosen as a second year in the leave cycle that started in
2007 The type of leave of absence is interpreted as a collective that does not specify the
type of sickness or illness or it being acute or chronic Workplace absenteeism is absence of
the employee at the workplace that is defined by Du Toit and Van Der Waldt (1998139) as
the place that the institution makes available and where officials have to perform their
work It forms part of the internal environment for public administration in the public
service Direct public administration is directly concerned with the rendering of services to
the citizens of the country
Chapter 4 discusses the study of workplace absenteeism in the four identified institutions
namely Tara Moross Centre Hospital Germiston Hospital ODI District Hospital and George
Mukhari Hospital In this research the following factors will be examined the organisational
structure and absenteeism of the different workforce categories such as medical and
nursing professionals administrative staff allied professionals and various categories of the
general assistants workforce and their relation to absenteeism in the institution
42 THE STRUCTURE OF THE ORGANISATION
The Gauteng Province is one of the nine provinces of South Africa In 2005 the auditor-
general conducted an audit of sick leave performance in six national departments and the
Gauteng Province was among those that were omitted from the audit The research focuses
on the Gauteng Department of Health (GDoH) whose core function is to provide health care
services to the people of Gauteng The provision of health care services is labour intensive
and requires large numbers of personnel for effective service delivery The GDoH is serviced
by thirty-four hospitals four of which have been identified for the study of management of
sick leave The employee attendance to work is essential to the achievements of the
Departmental goals The Determination on Leave of Absence determines the leave policy for
public service employees (DPSA 2009) The employees of GDoH represent the staff
component as reflected in the organisational structure of the department
38
The Gauteng Department of Health (GDoH) provides the basic health services to the people
of Gauteng who as internal or out-patients are clients or consumers of the services referred
to as line functions Public administration services rely heavily on support services such as
the personnel department that renders support to line functions that provide the actual
service of patient care Support services are considered as indirect public administration
services and essential in efficient public service delivery Workplace absenteeism has a
negative impact on productivity Employees of the Gauteng Department of Health and their
attendance to work are the focal point of the Province in terms of effective health care
service delivery that is customer focused
Political ideologies as those espoused by labour representatives are part of the external
factors in the workplace environment that consequently have an impact on public
administration and management and workplace attendance by employees (Du Toit amp Van
Der Waldt 1998139170)
FIGURE 41 INTERGRATED ORGANISATIONAL STRUCTURE
(Adapted from Gauteng Department of Health organisational structure 2010)
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY
The Gauteng Provincial Government has made a commitment to its people to account for
the delivery of services as its electoral mandate This commitment will be achieved only
when monitoring and evaluation of its performance is enforced by all Gauteng Department
of Health service providers
39
MEC
HOD
COP
Senior Exec
CD HAST CD Health program
Senior Exc
CD Tshwane
CD JHBWest
CFO
Manage Account
SENIOR CORPORATE
HRM amp LR
GenderampDisability
The Gauteng Governmentrsquos commitment to provision of health care services to all its
citizens is demonstrated by the decentralisation of management of service delivery with the
view to foster accountability increase efficiency and accountability (ANC 199419ndash20
Goldstein 200815) The interpretation of the analysed data takes the sector performance
approach into consideration when the interpretation of absence is across all the
occupational groups for the 2008 calendar year (Gauteng Province 201015)
44 COMPARISON OF HOSPITALSPERMANENT EMPLOYEES
Gauteng employees are counted at 51475 from the Personnel Salary Administration System
(PERSAL) as of March 2008 The population from the four chosen hospitals has been
counted at 4010 reflecting 8 of the total population The different groups of employees
were identified as Africans represented as n=3902 Whites as n=51 Indians as n=14 and
Coloureds as n=43
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALS
(Source Compiled by the researcher C S Ndhlovu 2012)
Figure 42 reflects the racial split percentage of the workforce (n=4010) of the hospitals
The population from the four hospitals has been counted as 4010 reflecting 8 (n=51475)
of the total working population for Gauteng Department of Health as from 1 January to 31
December 2008 The different groups of employees were identified as Africans represented
by 973 (n=3902) Whites as 13 (n=51) Indians as 03 (n=14) and Coloureds as 11
(n=43) The George Mukhari Hospital has a female dominated workforce at 739 (n= 2097)
in a total workforce of n=2836
40
Population n=4010
Africans 973
Whites 13
Coloureds 11
Indians 03
TABLE 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALS
RACE TARA HOSPITAL GERMISTON GEORGE
MUKHARI
ODI TOTAL
Africans 227 367 2836 472 3902
Whites 23 24 3 1 51
Coloureds 5 37 0 1 43
Indians 13 1 0 0 14
Population 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 1 focuses on the distribution of race and the population of the total workforce The
geographical area of the hospital determines the demographics and the tendency of some
groups being poorly represented or totally absent The research focused on permanent
employees of the four hospitals The George Mukhari Hospital employees are reflected as
7079 (n=2839) ODI Hospital as 1182 (n=474) Germiston Hospital as 1069 (n=429)
and Tara Moross Centre Hospital as 668 (n=268) of the total working population Tara
Moross Centre and Germiston Hospitals are located in cosmopolitan areas while the George
Mukhari and the ODI Hospitals are in rural and semirural areas The positioning of the latter
hospitals may account for the high African workforce
41
TABLE 2 COMPARISONS OF NUMBERS OF ADMINISTRATION AND SUPPORT STAFF IN THE
DIFFERENT HOSPITALS
OCCUPATIONAL
GROUP
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Administration
staff
48 60 297 61 466
Administration
support
103 140 719 133 1095
TOTAL 151 200 1016 194 1561
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 2 presents the administration employees and the administration support in the four
hospitals Tara Moross Centre Hospital is represented by 3179 (n=151) of administration
and 6822 (n=103) administration support The George Mukhari Hospital has the highest
representation by the administration support at 7077 (n=1016) The high representation
of the administration support staff at George Mukhari Hospital could be partly because of
the semi-rural environment A semi-rural environment is usually characterised by poverty
which may have a negative influence on opportunities to access education and skills
Doctors and nurses are highly marketable because of the educational levels and skills that
are lucrative and enable this group to be highly mobile geographically (Chaudhury amp
Hammer 20033)
42
TABLE 3 GENDER COMPARISON IN DIFFERENT HOSPITALS
GROUPS HOSPITALS MALE FEMALE POPULATION
Africans Tara 83 144 227
Germiston 52 315 367
George Mukhari 739 2097 2836
ODI 109 363 472
TOTAL 983 2919 3902
Whites Tara 5 18 23
Germiston 5 19 24
George Mukhari 3 0 3
ODI 1 0 1
TOTAL 14 37 51
Indians Tara 1 12 13
Germiston 0 1 1
George Mukhari 0 0 0
ODI 0 0 0
TOTAL 1 13 14
Coloureds Tara 1 4 5
Germiston 6 31 37
George Mukhari 0 0 0
ODI 1 0 1
TOTAL
GRAND TOTAL
8
1006
35
3004
43
4010
(Source Compiled by C S Ndhlovu 2012)
Table 3 focuses on gender distribution in the population of the research represented by
males and females in the different racial groups
43
The geographical area of the hospital determines the demographics and the tendency of
some groups being poorly represented or totally absent The males of the different hospitals
account for 251 (n=1006) while the females account for 749 (n=3004)
The George Mukhari Hospital has a female dominated workforce at 7394 (n=2097) out of
a total workforce of n=2836 White male employees are represented by 011 (n=3) against
the total workforce of the hospital (n=2839) There are no Indians and nor any Coloured
employees African males are represented by 2603 (n=739) The same hospital has no
white female employees no Indians no Coloureds and 7395 (n=2097) African females
The table reflects a predominantly African female workforce The hospital is situated in a
rural setting and this may have an impact on the vast difference in the gender
representation
The Tara Moross Centre and Germiston Hospitals are located in cosmopolitan areas They
have 187 (n=5) and 1117 (n=5) White male employees respectively and 672 (n=18)
and 443 (n=19) female employees respectively Tara Moross Centre Hospital has 4 48
(n=12) female Indian employees while Germiston Hospital has only 024 (n=1) Germiston
Hospital has 723 (n=31) female Coloured employees while Tara Moross Centre has 150
(n=4) The core function of the various hospitals may have influenced the gender
distribution
TABLE 4 COMPARISON OF TENURE OF SERVICE IN RELATION TO ABSENTEEISM IN THE
FOUR HOSPITALS
TENURE IN YEARS DAYS OF ABSENCE PERCENTAGE
1ndash10 4451 30
11ndash20 6577 443
21ndash30 2934 198
31ndash40 878 59
TOTAL 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 4 reflects the level of tenure of the total workforce from 1 year to 40 years of service
Tenure of 11 years to 20 years of service reflects 443 (n=6577) utilisation of leave of
absence and remains the highest rate of absenteeism followed by tenure of 1 to 10 years of
service at a 30 absenteeism rate
44
TABLE 5 COMPARISON OF THE OCCUPATIONAL GROUPS IN THE DIFFERENT HOSPITALS
OCCUPATIONAL
CATEGORIES
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Doctors 12 12 354 19 397
Professional
nurse
47 81 548 109 785
Staff nurse 15 53 358 56 482
Nurse assistant 16 50 308 55 429
Social worker 4 4 8 3 19
Occupational
therapists
4 0 15 1 20
Radiographer 0 3 27 6 36
Clinical
Psychologists
4 0 10 2 16
Physiotherapists 0 1 9 1 11
Dieticians 0 0 5 3 8
Finance 4 11 59 9 83
Speech
therapists
0 0 5 1 6
Pharmacists 2 9 36 5 52
Dentists 0 0 0 3 3
Technicians 2 5 51 6 64
Librarian 1 0 0 0 1
Security 6 0 30 1 37
Administration
and support
151 200 1016 194 1561
TOTAL 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 5 reflects a great difference in terms of number of occupational groups in the four
hospitals
45
The core function and the size of the hospital seems to have a bearing on how many
occupational categories of employees are to be found in that hospital as well as the actual
figures of these categories The George Mukhari Hospital is an academic hospital that trains
medical doctors This hospital has 1247 (n=354) doctors in a staff establishment of
n=2839 Tara Moross Centre has 448 (n=12) in a staff establishment of n=268 Germiston
has 280 (n=12) in a staff establishment of n=429 and ODI District hospital has 401
(n=19) in a staff establishment of n=474 This trend of vast differences in figures
represented by the occupational groups is evident in the category of professional nurses
where George Mukhari Hospital reflects 1931 (n= 548) nurses Tara Moross Centre is
represented by 1754 (n=47) Germiston by 1889 (n=81) and ODI District hospital by
23 (n=109) The impact of absenteeism is pronounced when viewed against the level of
facility capacity in terms of human resources of the core occupational groups
441 The Tara Moross Centre Hospital
Tara Moross Centre Hospital is a speciality psychiatric hospital in Region A with a workforce
of 669 (n=268) of the total workforce (n=4010) The core function of the hospital is
specialised such that some occupational categories are not available in the hospital as part
of the workforce and patients are referred out to other facilities for specialised treatment
Tara Moross Centre Hospital falls under the jurisdiction of the Johannesburg Metropolitan
Municipality
442 The Germiston Hospital
Germiston Hospital is a regional general hospital in Region B with a total permanent staff
establishment of 1070 (n= 429) of the total workforce (n=4010) The hospital falls under
the Ekurhuleni Metropolitan Municipality It does not have occupational therapists clinical
psychologists dieticians speech therapists and dentists in its permanent staff
443 The ODI District Hospital
The ODI District Hospital is in Region C and is in transition due to boundary changes It is
being transferred from the North West Province to the Gauteng Province The hospital is in
a semi-rural area with a staff component of 118 (n=474) of full-time employees (n=4010)
and falls under Tshwane Metropolitan Municipality It is a general district hospital
444 The George Mukhari Hospital
The George Mukhari Hospital is an academic hospital in Region C under Tshwane
Metropolitan Municipality The hospital trains doctors and employs 010 (n=3) White male
employees 26 (n=739) African males and7184 (n=2097) African females out of the
total female workforce (n=2919)
46
This phenomenon may be as a result of the hospital having the highest general assistants
workforce at 2065 (n=586) out of the workforce (n=2839) The George Mukhari Hospital
has the highest number of general assistants out of the four hospitals represented as 25
(n=719) in a total workforce of n=2836 African employees
45 RESEARCH INTERPRETATION
The interpretation of leave of absence is confined to salary level 1 to 12 full time employees
of the Gauteng Department of Health who took leave of absence from the workplace for the
calendar year in 2008 It excludes the contract employees periodic remuneration foreign
employees and permanent employees above salary range 13
The Basic Conditions of Employment Act 75 of 1997 Section 9 (3) (RSA 1997) prescribes
procedures in terms of progressive reduction of the maximum working hours to the goal of
a 40-hour working week and an eight-hour working day Finnemore and Van Rensburg
(2002462) state that the reduction of maximum working hours to 40 hours a week is done
through collective bargaining with due regard to job creation efficiency and health safety
and welfare of employees Du Toit and Van Der Waldt (1998232) use the formula to
aggregate lost working-man hours due to ill health and disability as aggregate lost hours in
the survey period divided by 40 hours in a week and x number of hours in a year A formula
to work out the absenteeism rate by Pierce (2009) is represented as A=BC A= Absenteeism
rate B= Total number of days lost due to absenteeism in a given period C= Total number of
working- man days available in the given period C=D x E D=Total number of employees
planned to work in the given period E=Number of available working days in the given
period
The approach of the research uses the principle of absence from the workplace when due to
work to identify the lost working hours (Pierce 2009 Davey amp Cummings 2009313) The
study applies a retrospective approach
The working-man lost days for the Province in the four hospitals is approached in terms of
lost working -man days simplified refers to the number of days meant to have been worked
but actually not worked due to illness or disability by the employees in a year divided by the
total number of employees of the public sector (PXVI) Barker (200779) argues that a
reduction in working hours increases the hourly cost of production and unit production
unless there is a commensurate increase in productivity This approach has a similar effect
on workplace absenteeism when the workload of those employees who are present
increases as they carry the double load to meet the demands of service delivery The cost of
absence to the Province is expressed as salary expenditure for each day of leave of absence
from the workplace (PSC 2002 xiii Pierce 2009)
47
The salary range is laid down according to Annexure in DPSA Circular 1 of 2008 The Gauteng
Government experienced a cost estimated at R29 million in 2000 and approximately R54
million in 2001 from absenteeism and loss of working time (Parbhoo20031)
The formula that is used in this research to calculate lost man work-hours is collective
working days of absence multiplied by 8 hours in a working day resulting in the total
working hours that are lost This formula can be represented as
Lost days x hours (8) in a working day = lost working hours
As stipulated by the Basic Conditions of Employment Act 75 of 1997 section 9 1(c) 3
TABLE 6 RACES IN RELATION TO ABSENTEEISM
RACE TOTAL DAYS OF ABSENTEEISM PERCENTAGE
Africans 14295 963
Whites 242 16
Coloureds 201 14
Indians 102 07
TOTALS 14840 100
(Source Compiled by the researcher 2012)
Table 6 represents absenteeism in the diverse races in the workplace The absenteeism rate
seems to be proportional to the number of employees The Employment Equity Act 55 of
1998 defines the term ldquoblackrdquo as a generic term which means Africans Coloureds and
Indians The Africans as a race group is represented by 963 (n=14295) of the total
working days lost (n=14840) The high figure of lost working-man days reflects the
demographics of the four hospitals The George Mukhari Hospital is in a rural setting that is
predominantly African populated and employs the highest number of Africans as
represented in table 3 Whites are presented by 16 and not represented in all
occupational categories and salary ranges that could explain the low figures and
percentages associated with working-man days lost Africans constitute the highest number
of employees as well as the highest percentage of working-man days lost Absenteeism
percentage is proportional to the employment figures for this race group The Indian race
group is represented by the lowest figure of employment and lowest percentage of leave of
absence which is proportional to the employment figure
48
TABLE 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM
OCCUPATIONAL
GROUPS
TARA GERMISTON ODI GEORGE
MUKHARI
TOTALS
DOCTORS 22 118 5 290 435
PROFESSIONAL NURSE 272 346 20 2459 3097
STAFF NURSE 128 247 13 1568 1956
NURSE-ASSISTANT 150 126 25 1145 1446
FINANCE 0 0 0 386 386
ADMINISTRATION 57 272 20 1923 2272
ADMIN SUPPORT 754 547 163 3784 5248
TOTAL 1383 1656 246 11555 14840
(Source Compiled by C S Ndhlovu 2012)
Table 7 reflects the working-man days lost by the different occupational groups The
doctorsrsquo workload in terms of the annual report for Gauteng Department of Health
(2008951) was 226 as against the target of 227 while the national target was 187
The bed occupancy rate target for the same time was 75 while the actual figure was
653 The annual report interpreted in conjunction with the data of leave of absence for
doctors reflects a negative impact in terms of service delivery and the cost factor to the
department
451 Occupational groups in relation to absenteeism
The multi-group invariance structural model presents different types of occupations and is
used to identify variance in the patterns in terms of occupational groups The model allows
different relationships between variables in different occupations The different
occupational groups are doctors professional nurses and sub-categories administration
staff and administration support staff (Pousette amp Hanse 2002230) According to Gaudine
and Gregory (2010599) absenteeism was a problem among health care workers in
comparison to other employees in other sectors The cornerstone of an efficient health care
service delivery is equity and efficiency which is threatened when employees are not at
work when expected to be (Andrews 199734-35 DPSA 1997)
49
According to the Charted Institute of Personnel Development (200811) the survey that was
conducted found that public sector employees are less likely to be disciplined or dismissed
for reasons of workplace absenteeism
Tables 5 and 6 and 7 reflect the different occupational groups and the level of absenteeism
in the four hospitals of the Gauteng Department of Health
4511 Doctors
Doctors are represented by 10 (n=397) of the total working population (n=4010) The
29 (n=435) indicates the number of working-man days lost in relation to the total
working- man days lost (n=14840) The percentage of working- man days lost in relation to
the total number of full time employees of the four hospitals is reflected as 435 divided by
n=4010 times the percentage which results in 108 (n=435) working-man days lost
multiplied by 8 hours that represent a working day The outcome is n=3480 working-man
hours The cost to the Province is calculated in terms of the salary expenditure as direct and
indirect salary payment for lost working-man hours estimated at 3480 hours at salary level
10 at R217 482 to salary level 12 at R 407745 as well as indirect costs such as replacement
of staff and overtime
The doctorsrsquo workload in terms of Gauteng Province 20089 annual report (2008951)
reflects the doctorrsquos workload as 226 as against the target of 227 while the national
target is reflected as 187 The bed occupancy rate target for the same time is 75 while
the actual target rate is 653 The annual report when interpreted in conjunction with the
data of leave of absence for doctors reflects a negative impact in terms of service delivery
and the cost factor to the Department when considering a loss of n=3480 man hours of
work
Chaudhury and Hammer (200311) found in their research that the doctors presented the
highest absenteeism rate Serneels et al (2008210) argue that absenteeism is rife in the
public sector where employees hold two jobs and is highest among doctors The doctor
absenteeism rate in the research does not stand out as high in comparison with the other
occupational groups The doctor absenteeism rate is 29 when compared to the total
workforce This occupational group is represented by 10 of the total population The
doctorsrsquo absenteeism rate does not seem to be outstandingly high in comparison with the
other occupational groups in relation to the total number of permanent doctors
50
4512 Professional nurses
The professional nursesrsquo absenteeism is reflected as 208 (n=3088) that indicates the
number of working-man days lost in relation to the total working-man days lost (n=14840)
The percentage of working-man days lost in relation to the total number of full time
employees (n=4010) in the four hospitals is reflected as 77 The cost to the Province
translates into direct and indirect salary expenditure which is spread from salary level 4 to
12 at R64 410 to R407 745 in 2008 for the total duration of lost working days
Du Toit and Van Der Waldt (1998232) pointed out a crisis in four other public hospitals in
the Gauteng Province that was caused by budget cuts and shortage of doctors and nurses in
2008 The vacancy rate of 697 in the professional nurse category and the absence rate of
208 in 2008 in the four hospitals seem to point to a lack of adequate human resources for
effective health care delivery The extent of working-man hours lost in the findings of the
research suggest a high rate of absenteeism and not a good reflection of happiness as
suggested in the annual report Professional nurses are second to the administration
support in absenteeism at 208 at a total of (n=785) nurses in the four hospitals with
absenteeism of n=3088 working-man days lost or n=20704 working-man hours lost This
category of employees is classified as skilled to highly skilled at salary range of 4 to 12The
total vacancy rate was at 697 as against the national target at 15 in 2008 with
absenteeism of 208 Madibana (201022) found in the research about absenteeism
among nurses that the high rate of absence had a negative impact in the quality of health
care rendered by nurses
4513 Staff nurses
Staff nurses are reflected in tables 4 and 5 as representing 12 (n=482) of the total working
population (n=4010) The 132 (n=1956) indicates the number of working-man days lost
in relation to the total working-man days lost (n=14840) times the percentage
The percentage of working-man days lost in relation to the total number of full time
employees in the four hospitals is reflected as 488 The cost to the Department is
expressed as direct and indirect salary expenditure for n=15648 working-man hours lost
The impact of leave of absence to health care services and cost to the Department is the
same as the professional nurses as staff nurses are a sub-category of the nursing profession
4514 Nursing assistants
Nursing assistants are reflected in tables 4 and 5 as represented by 107 (n=429) of the
total working population (n=4010) and 97 (n=1446) represent working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The
percentage of working-man days lost is reflected as 36 (n=1446) in relation to the total
number of employees in the four hospitals (n=4010)
51
The cost of leave of absence to the Department is expressed as the salary expenditure at
salary levels 3 to 6 Salary level 3 is at R54 876 salary level 4 is at R64 410 salary level 5 at
R76 194 and salary level 6 is at R94 000 for n=11568 working-man hours lost and staff
replacement and overtime
4515 Finance officers
Finance officers are reflected in tables 5 and 7 as represented by 21 (n=83) of the total
working population (n=4010) and 26 (n=386) indicates the working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The cost to the
Department is reflected as salary expenditure from salary level 2 at R47 787 to salary level
10 at R217 482 for R2 728 working hours lost The institutions reflected a small number of
this occupational category as permanent employees place them in the category of scarce
skills
4516 Administration staff
The administration staff is represented in tables 2 and 4 and 5 by 116 (n=466) in the total
working population (n=4010) and 153 (n=2272) indicates the working-man hours lost in
relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 567 represent the working-man days lost in relation to the total number of
full time employees in the four hospitals (n=4010) The cost of leave of absence to the
department is reflected as salary expenditure at salary level 4 to 12 Salary 4 at R64 410 to
salary level 12 at R407 745 for 18176 working hours lost
4517 Administration support
The administration support is reflected in tables 2 and 4 and 5 as represented by 273
(n=1095) of the total working population 354 (n=5248) indicates the working-man days
lost in relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 1309 (n=5248) indicates the working-man days lost in relation to the total
number of employees in the four hospitals (n=4010) The total cost to the Department is
reflected as salary expenditure at salary level 2 to 3 at a cost of R47 787 to R54 879 for
41984 working -man hours lost
The highest percentage of absenteeism in the different categories of employees in the four
hospitals is identified in the administration support category It is this category that falls into
the salary range of 2 and 3 which is classified in the Gauteng Province 20089 annual report
(20089325) as lower skilled employees This category represents the highest single
category of employees for the Department at n=1095
52
The impact to the core service delivery employees that require support from administration
staff would seem to be negative as the absence of employees from the workplace would
hamper the smooth workflow Barker (2007214-224) acknowledges the decline in the flow-
through rate in the school education higher grades namely Grade 11 and Grade 12 and
ventures to give possible reasons for this phenomenon The Gauteng Department of Health
as a possible employer has attracted a high percentage of the labourer category as
identified in table 3 totalling n=1095 which is 273 of the total workforce Pousette and
Hanse (2002230-231) suggest that the employeersquos authority to make decisions in his or her
job and the breadth of use of skills used by the employees at work become different aspects
of control with human service at work This approach suggests that reduced job autonomy is
associated with higher sickness absence The administrative support employees are involved
in mechanical or manual labour that predisposes them to musculo-skeletal problems The
work environment could have a negative impact to the high absenteeism rate in this group
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM AS REPRESENTED BY
THE HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 43 reflects the absenteeism rate of the different occupational groups as represented
by the hospitals The George Mukhari Hospital contributes 7079 to the total workforce
and contributes about 779 to absenteeism The absenteeism rate does seem to be low at
7 when considered in the light of the contribution The question that maybe be raised is
whether the relative low absenteeism is indicative of high morale of a happy workforce
53
ODI 17
TARA 93
GERMISTON 111
GEORGE MUKHARI 779
Germiston Hospital contributes 106 to the total workforce and the absenteeism is
reflected as 111 which seems to be above its contribution to the workforce by 1 The
professional nurse and the administration category present with the highest rate of
absenteeism in this hospital The Tara Moross Centre Hospital contributes 67 of the total
workforce and the absenteeism rate is at 93 which is 26 higher The administration
support and professional nurses present with the highest level of absenteeism in this
hospital The ODI Hospital contributes 6 to the total workforce and the absenteeism rate
which seems to be low is reflected as 17 This hospital has no access to the Persal system
and is dependent to a neighbouring hospital It is highly probable that the information is not
accurate
Allen (1984 331) found that union members might be absent more frequently from the
workplace than non-members because they face smaller penalties for absenteeism The
Charted Institute of Personnel and Development (CIPD) (200811) claim that the 2006
survey of absence management portrays the public sector employees as less likely to be
dismissed for reasons of workplace absenteeism
TABLE 8 SALARY RANGE IN RELATION TO ABSENTEEISM (SALARY RANGE 1-12)
SALARY RANGE DAYS OF ABSENCE PERCENTAGE
1-2 178 12
3-4 5235 353
5-6 2044 138
7-8 5139 346
9-10 1878 126
11-12 366 25
TOTAL 14840 100
(Source Compile by the researcher C S Ndhlovu 2012)
Table 8 reflects the salary range with the lowest working days lost as salary level 1 to 2 This
is proportional to the number of employees The highest absenteeism rate has been noted
in the salary range at level 3 to 4 while salary ranges at level 11 to 12 reflected a low rate of
absenteeism The latter salary range is at middle management level and the responsibility
the employees carry may be responsible for the low absenteeism rate Rogers and Hertin
(1993219) noted that the level of education seem to have influenced the use of sick leave
where the lower level category employees were found to have higher level of absenteeism
than higher educated employees
54
TABLE 9 AGE IN RELATION TO ABSENTEEISM
AGE IN YEARS DAYS OF ABSENCE PERCENTAGE
20 to 24 16 010
25 to 29 405 272
30 to 34 733 493
35 to 39 1582 1066
40 to 44 2676 1803
45 to 49 3318 2235
50 to 54 3046 2052
55 to 59 2235 1506
60 to 64 829 558
TOTAL 14840 9999(100)
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 9 reflects age in relation to absenteeism in the four hospitals The age group at 20 to
24 years reflects the lowest figure in working-man days lost at 010 (n=16 days)
Reday-Mulvey (200579) observed that employees over 45 years take marginally fewer short
sick leave days per year than those under 45years
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 to 55 years
as middle -age and shows this group as presenting with a high incapacity leave usage In the
research the age group 45 to 49 years presented with 2235 (n=3318) working-man days
lost and is the highest figure of absenteeism in all age groups The age group at 20 to 24
years is reflected as the lowest absenteeism rate in working-man days at 010 and this
could be related to the number of employees in this age group
According to Reday-Mulvey (20057988) and the Canadian Nurses Association (20065)
employees that are over 45 years take marginally fewer short sick leave periods but take
slightly longer sick days per year than those under 45 years and reflect higher absenteeism
in the age group above 50 years
55
Weeks (200454) found that employees at the age group represented by 51 to 60 years
show less absence which may be because of ill health retirement benefits The age 31 to 40
and 41 to 50 years show higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full time jobs and suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee In the study the age group 55 to 59 years show a decline in absenteeism in
comparison to 50 to 54 while age 60 to 64 shows the lowest rate
The aging employee has been found to expose the institutions to high levels of absenteeism
through a higher probability of becoming incapacitated for longer periods (Ferguson et al
200138) and the current research have pointed differently Rogers and Hertin (1993219)
found a significant correlation between the use of sick leave and age suggesting employees
with advanced age used more sick leave in comparison with the younger employees The
current socio-economic culture encourages retirement from active employment at the age
of 65 years and the research adopted that approach as a cut off point for employment
(Nichols amp Evangelisti 2001285)
TABLE 10 GENDER IN RELATION TO ABSENTEEISM
GENDER TOTAL
NUMBER
DAYS OF
ABSENCE
PERCENTAGE
Males 1006 2490 168
Females 3004 12350 832
Total 4010 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 10 reflects gender in relation to absenteeism The duration of working-man days lost
is higher in female employees at 8325 (n=12350) and is represented by 749 (n=3004) in
relation to the total number of employees in the four hospitals (n=4010) as represented in
table 3 The male employees employed by the Department are reflected as absent from
work by 1680 (n=1006) and represented as 251 in relation to the total number of
employees in the four hospitals (n=4010)
The Public Service Commission (PSC 200222) found that more males took sick leave than
females except for the age group of 16 to 19 years QUALSA (200923) noted that females
had the highest number of incapacity applications in comparison to their male counterparts
Qualsa attributed this pattern to the fact that female employees constitute a higher
percentage of the employee population within the Gauteng Department of Health
56
Roger and Hertin (1993222) noted that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees could have an
impact on the high number of absenteeism reflected by the women
452 Race in relation to absenteeism
The working population of the four hospitals is represented by four race groups such as
Africans Whites Coloureds and Indians
4521 Africans
Africans represent 973 (n=3902) of the total working population (n=4010) and 963
(n=14295) indicates the working-man days lost in relation to the total working-man days
lost (n= 14840) times the percentage 3565 (n= 14295) reflects the working-man days
lost in relation to the total number of employees in the four hospitals (n=4010) The 14295
working-man days lost are multiplied by 8 hours that represent a day and translates into
963 (n=114360) working-man hours lost The cost to the Department is translated as
salary expenditure for n=114360 workingndashman hours lost and the indirect cost of staff
replacement and overtime Africans constitute the highest number of employees as well as
the highest percentage of working-man hours lost Absenteeism percentage is proportional
to the employment figures for this race group
4522 Whites
Whites are represented as 13 (n=51) of the total workforce (n=4010) and 16 (n=242)
represent the working-man days lost in relation to the total working-man days lost
(n=14840) times percentage 61 (n=242) represent working- man days lost in relation to
the total number of employees in the four hospitals The 232 working-man hours lost are
multiplied by 8 hours that represent a working- man day that translates into 16 (n=1856)
working-man hours lost The cost to the Department is represented as salary expenditure of
(n=1856) working-man hours lost that is paid to the unproductive employees This race
group of employees is not represented in all occupational categories and salary ranges
which may explain the low figures and percentages associated with working-man days lost
(n=242) The demographics of the different hospitals may contribute to the low
representation of this group in the total workforce
4523 Coloureds
Coloureds are reflected as 11 (n=43) of the total workforce (n=4010) 14 (n=201)
represent working- man days lost in relation to the total working- man days lost (n=14840)
5 (n=201) indicates working- man days lost in relation to the total number of employees in
the four hospitals (n=4010)
57
The cost to the department is represented as salary expenditure for n=1608 working-man
hours that are lost This race group is represented in three of the four hospitals and not in
all categories and salary ranges which may explain the low representation and
absenteeism
4524 Indians
Indians represent 03 (n=14) of the total workforce (n=4010) in table 6 07 (n=102)
represent working- man days lost in relation to the total working- man days lost (n= 14840)
times percentage 25 (n=102) indicates working- man days lost in relation to the total
number of employees in the four hospitals (n=4010) The 102 working- man days lost are
multiplied by 8 hours that represent a working-man day and translates into 07 (n=816)
working- man hours lost The cost to the Department is expressed as salary expenditure
paid to the unproductive employees for duration of (n=816) working-man hours lost This
race group is not represented in two of the four hospitals in some occupational categories
and salary ranges The Indian race group is represented by the lowest figure of employment
and lowest percentage of leave of absence which is proportional to the employment figure
FIGURE 44 RACES IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 44 reflects the different races in relation to absenteeism The Africans as a race
group is represented by 963 of working-man days lost (n=14840) The high figure of lost
working-man days reflects the demographics of the four hospitals
58
14840 DAYS
(100)
Africans 963
whites 16
coloureds 14
Indians 07
The George Mukhari Hospital is in a semi-rural setting that is predominantly African
populated and employs the highest number of Africans as represented in table 1 (n=2836)
Whites are presented by 16 absenteeism rate and not represented in all occupational
categories and salary ranges which could explain the low figures and percentages associated
with lost working days The absenteeism rate for Indians is represented as 07 and
Coloureds as 14
The Africans as a race group constitute the highest number of employees as well as the
highest percentage of working days lost Absenteeism percentage is proportional to the
employment figures for this race group The Indian race group is represented by the lowest
figure of employment and lowest percentage of leave of absence which is proportional to
the employment figure The South African Survey Millennium (1999-200028) reflected the
African males in 1998 as 354 and females as 348 the Coloured males as 39 and
females as 46 Indian males as 39 and females as 15 and White males as 83 and
females as 94 There has been no significant change in the race group representation in
the working population of the four hospitals
453 Tenure in relation to absenteeism
Tenure in years is grouped in units of ten (10) Tenure in 1 to 10 years 11 to 20 years 21 to
30 years 31 to 40 years of all occupational groups are represented in figure 27 as the total
leave of absence utilised by the full-time employees of different occupational groups in
terms of tenure which translates into n=14840 working-man days lost The lowest hours lost
is at tenure 31 to 40 years of service which is reflected as 59 (n=878) working- man days
lost The highest working-man days lost is at tenure of service of 11 to 20 years reflected as
443 (n= 6577) working- man days lost Tenure of service of 1 to 10 years reflects 30
(n=4451) working-man days lost and tenure of years at 21 to 30 years reflects 198 (n=
2934) working- man days lost
Rogers and Hertin (1993222) express tenure as work experience in years that is viewed as a
predictor of employee productivity where seniority has been found to be inversely related to
absenteeism in terms of frequency and total number of work days lost The Canadian Nurses
Association (20065) suggests that job tenure increases with age as illustrated in their
research where nurses were found to have both job tenure of 20 years or more and are over
45 years of age In the research the tenure of 31 years to 40 years presented with the lowest
absenteeism rate in agreement with Rogers and Hertin (1993222)
59
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 45 reflects the total leave of absence from tenure of 1 year to 40 years The PERSAL
system reflected 40 years as representing more or less 64 years of age and 65 years is the
cut off point for full time employees in the system The lowest working- man days lost is at
tenure of 31 to 40 years of service which is reflected as 590 and represents the older
employee in general The highest working- man days lost is reflected at tenure of 11 to 20
which is presented as 4430 representing the younger employee This is an area of concern
as table 5 reflects professional nursesrsquo absenteeism rate at 208 and administration
support staff at 356 and is possible that the absenteeism rate of the two occupational
categories may be a bigger contributor to the high absenteeism rate reflected in the tenure
of 11 years to 20 years
454 Salary range in relation to absenteeism
The salary range is interpreted in the study as a salary broad band that is represented in
table 9 and ranges from level 1 to 12 Rogers and Hertin (1993 219) claim that the level of
education does seem to have a bearing on the salary range use of sick leave where the
lower level category employees were found to have higher levels of absenteeism than the
higher educated employee The Human Resource Development Strategy (Gauteng Province
200815214) claims that the chances of entering into a higher income bracket in South
Africa rises noticeably after people have twelve years of education The ages 20 to 24 years
are greatly affected by this assumption
60
0
20
40
60
Tenure 1-10Tenure 11-20
Tenure 21-30Tenure 31-40
30 4430
1980
590
Tenure
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 46 above reflects the salary range from 1 to 12 in relation to working- man days lost
as salary range 1 to 2 as n=178 working-man days lost which converts to 12 The highest
absenteeism rate has been noted in the salary range at level 3 to 4 at 3530 (n=5235)
working-man days lost while salary ranges at level 7 to 8 is reflected as the second highest
level of absenteeism at 346 (n=5139) lost working-man days
Salary range at 5 to 6 is reflected as the third highest in absenteeism at 138 (n=2044) lost
working-man days Salary range 9 to 10 is regarded as the entry point to middle
management and is reflected as the fourth highest at 126 (n=1878) working-man days
lost Salary range at 11 to 12 is regarded as middle management entrusted with high levels
of authority and accountability This group is reflected as losing 25 (n=366) working- man
days lost which is considered to be a reasonable low level of absenteeism
455 Age of full time employees in relation to absenteeism
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 years to 55
years as middle-age and shows this group as presenting with a high incapacity leave usage
In the research the age group of 45 years to 49 years is represented with 2235 (n=3318)
working- man days lost and is the highest figure of absenteeism in all age groups
61
178
5235
2044
5139
1878
366
0
1000
2000
3000
4000
5000
6000
Salary range1-2
Salary range3-4
Salary range5-6
Salary range7-8
Salary range9-10
Salary range11-12
DAYS OF ABSENTEEISM
Reday-Mulvey (20057988) and Canadian Nurses Association (20065) observed that
employees over 45 years take marginally fewer short sick leave periods but take slightly
longer sick days per year than those under 45 years and reflect higher absenteeism in the
age group above 50 years
Weeks (200454) claims that the age group at 51years to 60 years show less absence may be
because of ill health retirement benefits The age group of 31 years to 40 years and 41years
to 50 years show a higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full-time jobs He suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee The aging employee has been found to expose the institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods
(Ferguson et al 200138)
Rogers and Hertin (1993219) claim that there is a significant correlation between the use of
sick leave and age suggesting employees with advanced age comparatively used more sick
leave in comparison with the younger employees The current socio-economic culture
encourages retirement from active employment at the age of 65years and the research
adopted that approach as a cut off point for employment (Nichols amp Evangelisti 2001285)
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 47 reflects the number of working-man days lost by full-time employees through
absenteeism related to a specific age
62
16
405
733
1582
2676
3318
3046
2235
829
0
500
1000
1500
2000
2500
3000
3500
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Days of absence
Days of absence
Age groups are organised in units of 5 to be consistent with the Personnel and Salary
Administration System (PERSAL) The age group at 20 years to 24 years reflects the lowest
percentage of absenteeism at 010 (n=16) working-man days lost and the age group of 45
years to 49 years reflect the highest days of absenteeism at 2235 (n=3318)
456 Gender in relation to absenteeism
The females employed in the Department of the four hospitals are represented as 749
(n=3004) in relation to the total number of employees in the four hospitals (n=4010) and
lost 8320 (n=12350) working-man days This absenteeism rate is considered high
considering that not every female employee may have used sick leave The male employees
employed in the Department are represented by 25 (n=1006) of the total workforce
(n=4010) and lost 168 (n=2490) working-man days The findings suggest that males
utilised fewer days of sick leave considering the fact that not every male employee may
have utilised sick leave for the duration of the study
The Public Service Commission (PSC 200222) claims that more males took sick leave than
females except for the age group of 16 years to 19 years QUALSA (200923) noted that
females had the highest number of incapacity applications compared to their male
counterparts Qualsa attributed this pattern to the fact that female employees constitute a
higher percentage of the employee population within the Gauteng Department of Health
Rogers and Hertin (1993222) argue that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees may have an
impact on the high rate of absenteeism
63
FIGURE 48 GENDER IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 48 reflects gender in relation to absenteeism The females employed by the
department in the four hospitals are reflected as absent from work at a rate of 8320
(n=12350) working-man days and represented by 749 (n=3004) in relation to the total
number of employees (n=4010) in the four hospitals The male employees employed by the
Department are reflected as absent from work at 1680 (n=2490) and represented as
251 (n=1004) in relation to the total number of employees in the four hospitals
(n=4010)
457 Week days in relation to occupational groups
Table 11 reflects the trends in terms of days of the week that show high utilisation by the
different occupational groups Mondays Fridays and Thursdays reflect a high utilisation rate
by the employees suggesting a pattern of high absenteeism rate over weekends
Professional nurses and sub-categories and the administration support group reflected the
highest absenteeism over the weekends
64
1680
8320
000
1000
2000
3000
4000
5000
6000
7000
8000
9000
Males Females
GENDER ABSENCE
TABLE 11 WEEK DAYS IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
OCCUPATIONAL
CATEGORY
MONDAY TUESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Doctors 18 8 13 17 0 0
Professional
Nurse
135 86 94 137 0 0
Staff Nurse 52 38 56 65 2 0
Nursing
Assistant
62 27 34 45 2 0
Administration
Staff
64 38 58 73 1 0
Administration
support
252 147 98 126 26 15
Finance officer 17 4 8 16 0 0
TOTAL 600(4) 348(23) 361(24) 479(32) 31(02) 15(010)
(Source Compiled by C S Ndhlovu 2012)
Table 11 reflects the pattern of how the different occupational groups utilised sick leave on
the different days of the week It illustrates the days that sick leave started on each day of
the week The largest number of incidences of sick leave commence on Monday the first
working day of the week as reflected by 4 (n=600) of the days of the weekend Fridays are
the second highest days of absenteeism represented by 32 (n=479) Tuesdays and
Thursday are almost the same in utilisation as reflected by 23 and 24 respectively
Professional nursesrsquo absenteeism was pronounced on Mondays as 2250 (n=135) and
Fridays as 2861 (n=137) a trend that shows possible long weekend absenteeism
The administration support staff has been reflected as mostly absent on Mondays 42
(n=252 days) and Fridays 2631 (n=126 days) The administration support reflected the
highest days of absenteeism on Saturday (n=26) and Sunday (n=15) The Canadian Nurses
Association (CNA) (2006) focused on seasonal pattern of absenteeism in the different
categories in the different hospitals The PSC (2002) report identified a trend by provincial
employees of using sick leave to extend their weekends The research considered working-
man days lost in terms of days of absence as in accordance with evidence of a medical
certificate Administration support is the only group that seem to have utilised Saturdays
for sick leave 8387 (n=26) and Sundays 100 (n=15) days
65
TABLE 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALS
INSTITUTIONAL
CONTRIBUTION
TARA MOROSS
CENTRE
GERMISTON ODI GEORGE
MUKHARI
TOTAL
Contribution to
Sample
668 1070 1182 7080 100
Contribution to
Absenteeism
842 1177 165 7816 100
(Compiled by C S Ndhlovu 2012)
Table 12 reflects the contribution of each hospital to absenteeism Tara Moross Centre
Hospital contributed 67 to the sample and the absence rate is higher than the
contribution at 84 The Germiston Hospital contributed 107 to the sample and the
absenteeism rate is higher at 117 The George Mukhari Hospital contributed 708 to the
sample and absenteeism rate is at 782 and ODI Hospital contributed 118 and
absenteeism rate is at 17 The latter hospital has no computers at The reflection of the
status of absenteeism is likely to be inaccurate The George Mukhari Hospital has the
highest contribution to the sample yet leave of absenteeism is tolerable It raises questions
as to what should be the contributory factor to the leave of absence status in this hospital
46 CONCLUSION
Chapter 4 presented the analysed data in terms of the characteristics as determined in the
stratified random sampling The characteristics and their association with absenteeism have
been presented such as occupational categories age gender tenure of service and race
The research identified which days of the week were utilised for sick leave absence The
contribution of each hospital to absenteeism was identified and a brief overview of each
hospital was presented
Chapter 5 presents the findings conclusion and recommendation of the research
66
CHAPTER 5
FINDINGS CONCLUSIONS AND RECOMMENDATIONS
51 INTRODUCTION
Chapter 1 provides a general introduction to the research It included the background and
motivation for the research that provides the context the problem statement and the
significance of the research The key concepts are defined The research design the method
of data collection the sampling method data analysis and interpretation and limitations to
the research are explained in this chapter
Chapter 2 considers the theoretical foundations concepts characteristics theories
approaches and classifications of workplace absenteeism The discussions on the conceptual
framework of absenteeism predictors of absenteeism and various models of absenteeism
are presented Measures to control workplace absenteeism and the impact of absenteeism
in an institution and management intervention strategies in workplace absenteeism were
discussed
Chapter 3 describes the research design and the different aspects of the research methods
that were applied to the research The chapter explains the various data collection
techniques that are used unit of analysis units of observations construct validity and
ethical considerations
Chapter 4 provides the organisational structure of the Gauteng Department of Health
comparisons of hospital employees different race groups of the four hospitals gender
comparisons in different hospitals and comparisons of the different occupational groups It
provides a short description of the target hospitals The research interpretation is discussed
in terms of the different occupational groups and absenteeism different races and
absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism The trends of week days of
absenteeism in the four hospitals and contributions to absenteeism by the four hospitals are
presented
Chapter 5 explains a synthesis of the study and evaluation of workplace absenteeism The
findings of the research and recommendations are discussed
52 FINDINGS
The findings of the research reflect doctors as represented by 108 in the total workforce
(n=4010) have an incidence of 29 (n=435) of the total work-man days lost (n= 14840) by
the employees in the four hospitals translating to a total of n=3480 working hours lost
67
The working-time lost is considered against the doctorsrsquo workload of 226 in contrast to the
target of as 227 while the national target was 187 The bed occupancy rate target was 75
while the actual figure was 653 The annual report when it is interpreted in conjunction
with the sick leave absence of doctors at 29 shows no negative impact on the workload in
terms of service delivery The negative impact is mainly on the cost factor to the state as the
doctorrsquos salary level is from salary level 10 at a cost of R217482 to salary level 12 at
R407745 (Gauteng Province annual report 2008951) Serneels et al (2008210) claim that
absenteeism occurs primarily in the public sector associated with people who hold two jobs
and that is highest and more frequent amongst doctors The findings of the research of
absence of 29 with a contribution of 2 to the sample are in disagreement with the
Serneels et al findings
Professional nurses represent 196 (n=785) of the total workforce (n=4010) The
workplace absenteeism is represented as 77 (n=3088) of the total workforce (n=4010)
translating into 21 of working-man days that are lost (n=14840) The absenteeism rate
appears to be very high given the fact that nurses by virtue of their numbers are the
backbone of health care service delivery (DPSA 2009) The Gauteng Province annual report
of 2008951 reflects the total vacancy rate of nurses at 697 as against the national target
of 15 The absenteeism rate of 77 is very high when compared with the total vacancy
rate and 19 contribution to the sample Staff nurses are a sub-category of the nursing
profession and the impact of their absence to service delivery is the same as the
professional nurses The findings of the study reflect staff nurses representing 12 (n=482)
of the total working force (n=4010) The absenteeism from staff nurses is reflected as 13
(n=1956) of the total working-man days lost (n=14840) The absenteeism rate does appear
to be high when considering the contribution of 13 to the absence rate by a sample of 12
to the total working-man days lost Nursing assistants are a sub-category of the nursing
profession that is reflected as 107 (n=429) of the total number of employees (n=4010)
and represent 97 (n=1445) of the total working-man days lost (n=14840) This absence
rate is considered as high when compared with the total number of employees
The nursing occupational group considered collectively contributed to absenteeism at the
workplace at 997 which is extremely high Davey and Cummings (2009312-313) claim
that frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased
staff morale and high cost to health care The high absenteeism rate has a negative impact
on health care service delivery
The findings of the research reflect administration staff as 116 (n=466) of the total
number of employees (n=4010) represented by 154 (n=2286 days) of the total working-
man days lost (n=14840) Administration support is at salary level 1 to 2 with exceptional
instances of salary level 3 to 4
68
Administration support staff is reflected as 273 (n=1095) of the total workforce (n=
4010) represented by 356 (n=5289 days) of the total working-man days lost (n=14840)
translating to n=42312 lost working-man hours
The administration staff viewed collectively contributed 51 to absenteeism which is very
high with the support staff reflected as 356 Rogers and Hertin (1993219) claim that the
level of education seem to have influenced the use of sick leave where the lower skilled
category of employees were found to have higher levels of absenteeism than higher
educated or skilled employees The findings of the research reflect the administration
support staff to be in line with the Roger and Hertin findings
The Gauteng Department of Health has a limited number of finance officers causing them to
be a scarce skill occupational group The finance officers represent 2 (n=83) of the total
workforce (n=4010) The working-man days lost are reflected as 23 (n=341) of the total
working-man days lost (n=14840) The total absence at 23 is higher than the actual
contribution to the sample at 2
The age group of 45 years to 49 years reflects the highest absenteeism rate at 224
(n=3318) the age group at 50 years to 54 years is reflected as 205 absenteeism The age
group 40 years to 44 years reflected as 18 absent from the workplace The age group of 55
years to 59 years is reflected as 15 absenteeism Employees of advanced age used more
sick leave in comparison with the younger employees This phenomenon could be attributed
to the ageing process of the body and the onset of incapacity Absenteeism has been found
to be higher in employees who are over 50 years of age and the phenomenon is attributed
to age and changing abilities that increase when work is performed full- time The findings
of the research reflect the age group over 50 years at 205 and reflect the highest
absenteeism rate at age 45 years to 49 years as 224 (McGoldrick amp Arrowsmith 200184
MINTRAC 20093 Nichols amp Evangelisti 2001285 Reday-Mulvey 200579-194) According to
Ferguson et al (200138) the aging employee presents with high levels of absenteeism
through higher probabilities of becoming disabled for longer periods The findings of the
study reflect absenteeism of the age group of 55 years to 59 years at 15 which is the
lowest in the age groups The Canadian Nurses Association in (20065) noted a reduction in
workplace absenteeism rate among nurses who are less than 45 years of age and an
increase in the absenteeism rate among nurses above 55 years of age According to Bangali
(20043-4) the falling rate of the older employee age group could be influenced by the
practice of early retirement or voluntary severance which was used in the 1990s as a
method of restructuring in institutions Rogers and Hertin (1993219) claim employees with
advanced age used more sick leave in comparison with the younger employees
69
The group at tenure 11 to 20 years presented with the highest level of absenteeism at
443 The employee at tenure of 21 to 30 years presented with 198 of absenteeism rate
while the employees at 1 to 10 years presented with the rate of 30 The findings of the
research reflected tenure of 31 to 40 years to have presented with the lowest absenteeism
rate at 59 (n=878 days) This low absenteeism rate could be ascribed to the fact that
numbers of employees are reduced in this group or could also be commitment to their jobs
or could have higher ambition levels to aspire to higher posts
Van Der Westhuizen (2006136) and Rogers and Hertin (1993222) express tenure as work
experience that may be viewed as a predictor of employee productivity where seniority has
been found to be inversely related to absenteeism in terms of frequency and total number
of working-man days lost The public service employees enjoy security of tenure which may
contribute to the unacceptably high levels of absenteeism (Andrews 1997221ndash222
MINTRAC 20093)
The findings of the research reflect females as 75 of the total workforce (n=4010)
represented by 832 (n=12350) of the total working-man days lost (n=14840) The males
represent 25 of the total workforce (n=4010) and are reflected as absent at 168
(n=2490) of the total days of absence (n=14840)The absenteeism rate is very high for
females in this research Rogers and Hertin (199322) and Van Der Westhuizen (2006136)
suggest that women are absent from workplace more than men are Landstad et al (20011)
found that women cleaners who received preventive personnel support depicted a
reduction in absenteeism rate Hoxsey (2010562) claims that although women presented
with a high score of job satisfaction than men they maintained higher levels of
absenteeism MINTRAC (20094ndash8) found that gender moderates the age turnover
relationship Women are more likely to remain in their jobs the older they get than men do
The findings of the research reflect Africans as represented by 26 of the working
population and utilised 963 of the total working-man days lost due to sick leave It is
possible that the overall number of Africans influenced what seems to be a high level of
absenteeism at 963 Whites represented 03 of the working population and
absenteeism is reflected as 16 of the total working-man days lost Coloureds are
represented by 03 of the working-man population and absenteeism was recorded as 14
of the working-man days lost The Indians are represented by 01 of the total working
population and are reflected as 07 of the working-man days lost
The findings of the research reflect the salary range at level 11 to 12 utilised 25 working-
man days for sick leave salary level 7 to 8 which is the supervisory level utilised 346
working-man days lost salary level 3 to 4 which is the entry level of skilled workers utilised
353 working-man days lost The findings suggest management used fewer days of sick
leave in comparison to the supervisory level and entry skilled worker level
70
This can be ascribed to the fact that they are ultimately responsible for the institutionrsquos
effectiveness and productivity
The George Mukhari Hospital contributed 708 to the sample and reflected 771
absenteeism which is relatively low in comparison to the size of the contribution It could be
that processes and procedures of controlling leave of absence are in place The Tara Moross
Centre Hospital contributed 67 to the sample and reflected 93 absenteeism rate that is
high by 26
Professional nurses reflected a trend of high absence over the weekend including
Thursdays This could be a sign of burn out and extending the period of rest from possible
high workloads resulting from high vacancy rates (Gauteng Province annual report 20089)
Nyathi (200059) and the PSC (2002) found that employees are absent from work because
they want to prolong the weekend
53 CONCLUSIONS
The absenteeism rate is very high for females in this research The aging employee presents
with high levels of absenteeism through higher probabilities of becoming disabled for longer
periods The use it or lose it approach of the current system rewards the abuse of sick leave
as it is viewed as not being beneficial by the employees to act responsibly towards the use
of sick leave
The vacancy rate of 697 in the professional nurse category and the absence rate of 208
in 2008 in the four hospitals can only suggest inadequate levels of human resource for
effective efficient quality health care services at a high cost to the Province The nurses
may not be aware of the actual absenteeism or they under-estimate it The combination of
high registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery
Professional nurses and administration support staff have absented themselves from the
workplace predominantly on Mondays and Fridays It could be for various reasons ranging
from feelings of burn out to extending the weekend
The percentage of working-man days lost in relation to the total number of full-time
employees in the four hospitals is reflected as 488 which is very high as there is no
deterrent not to abuse sick leave in the public sector The findings of the research found a
significant correlation between the occupation and use of sick leave age and the use of sick
leave gender and use of sick leave and tenure and use of sick leave
71
The biggest hospital George Mukhari presented the lowest rate of absenteeism for its size
and complexity which reflects an empowered management The Tara Moross Centre
Hospital is the smallest hospital highly specialised and presented with high rate of
absenteeism for its contribution which may be a reflection on the skills of its management
or the type of health care service that is offered by the institution
The international norm of absenteeism is 3 The research established the absence rate at
488 The Gauteng Department of Health is held at ransom by the five trade unions it has
signed agreements with and that makes it difficult for managers to manage absenteeism
The practise of Gauteng Department of Health Head office to remove managers from
institutions when there is a labour unrest exacerbates the problem of managing
institutions
The findings of the research could not establish a representative reflection of race and
absenteeism as Indians Coloured and Whites were not represented in some institutionsrsquo
demographics
54 RECOMMENDATIONS
The White Paper on Transforming Public Service holds management responsible for
delivering specific levels of services and for obtaining value for money in wider utilising of
resources This strategy is to be translated into action The Gauteng Department of Health
should probably benefit by adopting the total absence management philosophy by
cultivating a culture that is not tolerant of high levels of absenteeism through building it in
as a key performance area of the performance of all managers and all employees The
current performance dimension system should lay explicit emphasis on this aspect
The re-engagement of knowledge based and professional retirees at reasonable
remuneration levels to reward their expertise may assist in reviving good work ethics by
mentoring the new and generally young recruits The retired professionals are currently
resisting the call for re-employment on a contract basis at entry level
The Gauteng Department of Health can encourage flexitime in terms of 58 or 68 to allow
the mature employee to remain within the system with the view to share their knowledge
and skills with the young employees who may be highly qualified but lack experience This
approach may deal with the need for adequate human resources for health care delivery at
reduced cost as two employees on flexitime basis can occupy one full-time employeersquos post
Managers should use the return-to-work counselling strategy to solicit feedback from the
employee about the actual absenteeism The counselling should be on a one-to-one basis
This approach may raise self-awareness to the employees in terms of the impact of the
employeersquos absence frothed workplace
72
Currently this intervention strategy is not adequately utilised for fear of confrontation with
labour representatives
Managers should have attendance policies in place effectively communicate policies to
employees adhere to policies and procedures and use absence control strategies
consistently This approach will minimise the feeling of injustice by employees Currently the
human resource unit is challenged by a high staff turnover due to promotions from the
human resource area a situation that creates a vacuum and lack of continuity weakening
the process of empowering line managers by human resource practitioners This high staff
turnover may be controlled through upgrading of the human resource salaries as the
salaries fall out of the occupation service dispensation (OSD)
Managers in the public service are expected to be responsible and accountable for their
portfolios including management of leave of absence and should not shift it to the human
resource unit as is currently the practice It should be possible to charge a manager as an
accomplice for failing to manage the absence of employees where there is no evidence of
corrective remedial action where it has been warranted The researcher takes cognisance of
the fact that the public service is highly unionised and this approach may trigger industrial
action
The employer needs to revive on the job in-service education and training as a way of
imparting institutional values such as attendance at the workplace in partnership with
recognised labour representatives through bilateral and multilateral forums and through
institutional skills development committee which should be representative of all
stakeholders with the view to promote stability in the workplace and indirectly enhance
productivity and reduce workplace absenteeism Currently the bilateral multilateral and
skills development committees are inactive in the institutions that were targeted and
management seems to be intimidated by the militant labour representatives
High levels of absenteeism among some occupational groups do suggest a need for an active
employee assistance programmes at all hospitals Employee wellness committees are
currently inactive There is a sporadic intervention approach at some institutions where
PILIR Committees are active Employee assistance programmes should be budgeted for as a
standing on-going programme in all hospitals There is a need for a thorough research as to
why absenteeism remains high in the public service and focus on absenteeism broadly
73
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Erasmus B Swanepoel B Schenk H Van der Westhuizen EJamp Wessels JS 2005 South
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Ferguson T D Muedder Kamp Fitzgerald R M2001 The case of total absence
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Finnemore M amp Van Rensburg R 2002 Contemporary labour relations Johannesburg
LexisNexis
Gaudine A amp Gregory C2010The accuracy of nursesrsquo estimates of their absenteeism
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Ghauri P Gronhaug Kamp Kristianslund I 1995 Research methods in business studies
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Goldsmith Mamp Morgan H 2003 ldquoLeadership is a contact sport The ldquofollow up factorrdquo in
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Goldstein M2008Why measure service delivery Are you being serviced New tools for
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Grogan J 2003 Workplace law 7 th edition Lansdowne Juta
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Hirschfield RR Schmitt LPamp Bedeian GA2002 Job-content perceptions performance-
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Hoxsey D2010Are happy employees healthy employees Researching the effects of
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Jacobs EJamp Roodt G 2011 The mediating effect of knowledge sharing between
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Jankowitz E 1991Terminating for absenteeism practical labour management Rivonia IR
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Keese M2006 Live longer work longerDELSA Newsletter OECD Available at
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Lambert EG Camp SD Edwards Camp Saylor WG 2005 Here today gone tomorrow
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Landstad B Vinberg S Ivergard TT Gelin G ampEkholm J2001Change in pattern of
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LexisNexis 2006Labour Law Reports July 1994ndashDec2006CumulativeIndex Durban
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LexisNexis 2007 Legislation and strategyLexisNexis (9)Durban Butterworths Available at
httpwwwmylexisnexiscoza (Accessed on 15072011)
Madibana LF 2010 Factors influencing absenteeism amongst professional nurses in
London Pretoria University of South Africa
Markussen S Rogeberg OJ amp Gaure S 2009 The anatomy of absenteeism IZA
Discussion Paper Series No 4240 June Bonn Institute for the Study of Labor
McCormick ET amp Ilgen D1985 Industrial and organizational psychology 8th edition New
Jersey Prentice-Hall
McGoldrick E amp Arrowsmith JJ 2001Discrimination by age the organizational response
Ageism in work and employment Edited by Glover IampMohamed Sterling Management
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Mellor N Arnold Jamp Gelade G2009The effects of transformational leadership on
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MINTRAC 2009 Literature review on labour turnover and retention Available at
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Mouton J2005How to succeed in your Masterrsquos and Doctoral studies a South African guide
and resource book Pretoria Van Schaik
Munro L 2007 Absenteeism and presenteeism possible causes and solutions The South
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Nel PS Gerber PD Van Dyk PS Haasbroek GD Schultz HB Sono TampWerner A
2001 Human resource management5th edition New York Oxford
Nel PS Kirsten M Swanepoel BJ Erasmus BJampPoisant P 2008South African
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Nichols AampEvangelisti W2001 Fitness for work the effect of aging and the benefits of
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Nyathi MN 2000Factors contributing to absenteeism among nurses a management
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Patrick MN 2001Positive psychological functioning among civil servantsPretoria
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Parbhoo S2003 Why worry about absenteeism in the workplace CCMA PublicationCCMA
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Polit DF amp Hungler BP 1995 Nursing research principles and methods Philadelphia
Lippincott
Pousette A amp Hanse JJ 2002Job characteristics as predictors of ill-health and sickness
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Reday-Mulvey G 2005Working beyond 60 key policies and practices in Europe New York
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Republic of South Africa 2011 ldquoTowardsquality care for the patientrdquo National Core
Standards for Health Establishments in South Africa Pretoria Government Printers
Robbins SP amp Decenzo DA 2001 Fundamentals of management essential concepts and
applicationsNew Jersey Prentice Hall
Robbins SP Odendaal A amp Roodt G2004Organizationalbehaviour Global Southern
perspective 5th impression Cape Town Pearson
Rogers RE amp Hertin SR 1993Patterns of absenteeism among government employees
Public Personnel Management22 (2)Available at httpwwwquestiacom (Accessed on
10012009)
Serneels P Lindelow MampLievens T2008Qualitative research to prepare quantitative
analysis absenteeism among health workers in two African countriesAre you being
serviced New tools for measuring service deliveryEdited by Amin S Das
JampGoldsteinM2008 The International Bank for Reconstruction and DevelopmentThe
World Bank for Reconstruction and Development Washington D C The World Bank
Slabbert JA amp Swanepoel BJ 2001Introduction to employment relations
managementDurban Butterworths
South African Survey Millennium1999-2000 Johannesburg South African Institute of Race
Relations
Steers RMamp Rhodes SR 1978Major influences on employee attendance a process
model Journal of Applied Psychology63 (4)391-407
Oi-ling S2002Experience before and throughout the nursing careerPredictors of job
satisfaction and absenteeism in two samples of Hong Kong nursesJournal of Advanced
Nursing 40 (2)218ndash229 Available on httpwwwebscohostcomoasisunisaacza
(Accessed on 10072011)
Todd C2001Contract of employment Claremont Siber Ink
Tonya TW2001Minimizing absenteeism in the workplace strategies for nurse managers
Nursing Economics19 (2 MarApril) 53 3 Available at httpwwwoasisunisaacza
(Accessed on 14012009)
Tustin C 1994Industrial relations a psychological approach1st edition Halfway House
Southern Publishers
80
Unruh Jamp Strickland M2007 Nurse absenteeism and workload Negative effect on
restraint use incident reports and mortality JANORIGINAL RESEARCH Journal compilation
Florida Blackwell
Van der Westhuizen C 2006Work related attitudes as predictors of employee absenteeism
Pretoria University of South Africa
Venter R 2003 Labour relations in South AfricaRevised edition Cape Town Oxford
University Press
Viviane IJ 2011Absenteeism among women workers in industry85 IntrsquoLab Rev 248
(1962) Available at httpwwwHeinonlineorg(Accessed on 18052012)
Weeks KL 2004 Development and initial characteristics of a comprehensive survey on
workplace absenteeism Logan Utah State University Available on
httpwwwoasiscomunisaacza(Accessed on 14012009)
Welman JC amp Kruger SJ2001Research methodology for the business and administrative
sciences 2nd edition New York Oxford
Yende PM 2005 Utilising employee assistance programmes to reduce absenteeism in the
workplace JohannesburgUniversity of Johannesburg
81
ANNEXURES A B C
ANNEXURE A
PROCESS EVALUATION QUESTION COMPLIANCE
YESNO
ACTION PLAN
Retention and Reward -
leave
1 Are there complete and
accurate Z 1(Leave application
forms) forms on file
2 Have all application forms been
approved stamped and
registered
3 Have all forms been captured
on the Persal with the following
requirements
Supporting documents
A 10 day compulsory leave
processed within the annual
leave cycle Determination of
Leave
4 The remaining days are utilized
6 months from the end of the
leave cycle
5 Are there unutilized leave days
6 Has there been adequate
checking of leave reasons
Leave credits
Adherence to leave categories
(i)Normal ( ii) Incapacity
(iii) Injury on duty (iv) Maternity
(v)Adoption (vi) Family
responsibility
(vii) Office bearersshop stewards
and Casual Employees
7 Have work reasons been
provided for leave days
(Source Compiled by C S Ndhlovu 2012)
82
ANNEXURE B
Retention and
reward ndashsick leave
Evaluation Question Compliance YesNo Action Plan
1 Are there medical
certificates that have been
submitted to all medical
claims with the following
Specific illness stated
Supporting documents on
file
2 Has the 8 week rule for
36 days in a 3 year cycle
been adhered to
3 Are there complete
medical certificates for 3
days or more sick leave
days for normal sick leave
4 Are all other leave days
above 3 days utilized after
36 days treated as
temporary incapacity
leave
5 Are temporary
incapacity leave forms
submitted within 5 working
days after the first day of
absence
6Is there a register for
temporary incapacity
leave for 1 to 29 days lead
time for reporting leave
applications
7 Has the employer
approveddeclined the
leave application within 30
working days of receipt
(Source Compiled by C S Ndhlovu 2012)
83
ANNEXURE C
CHECK LIST
Is there a leave register in place for all leave applications
1 Is leave approved prior to the employee proceeding on leave
2 Area attendance registers maintained and up to date
3 Are periodic audits for leave carried out
4 Is there evidence of GSSCrsquos approval on leave applications
5 Are leave forms accurately captured on Persal
6 Are leave forms accurately completed by applicants
7 Is movement of leave forms monitored between the GSSC and institutions
8 How is rejected leave application dealt with
(Source Compiled by C S Ndhlovu 2012)
84
ACKNOWLEDGEMENTS
This work is dedicated to my late son Neville Ndhlovu my loving husband Errol Ndhlovu
who has been my pillar of strength my son John Ndhlovu for the unwavering
encouragement throughout this tough journey my nuclear family without whose support
during the grieving period I would not have completed this research I would like to
acknowledge my daughter-in-law Vuyelwa Ndhlovu and my lovely grandchildren Nhlamulo
and Ntsako Ndhlovu who are the sunshine of my life who allowed me to work on
ldquoProfessorrsquos workrdquo as they referred to the research I thank God who made it possible for
me to stay on track during the darkest hour in my life
I wish to extend my sincere gratitude to Professor Pauw who believed in me my
supervisor Professor S B Kahn who remained a beacon of hope during the most trying time
in my life Professor S B Kahn and my joint supervisor Mr A Van Schalkwyk offered valuable
professional guidance that ensured that the research met the required academic standard
I wish to extend my sincere gratitude to Mrs Marti Gerber who dedicated herself editing
this document
I am aware that there are others who also assisted in different ways whom I might have
omitted to mention in my acknowledgement who made it possible for me to complete the
task at hand The quality of your efforts and assistance is evident in the final product May
God bless you all in your generous efforts towards completion of this research
IV
GLOSSARY
ANC = African National Congress
BCEA=Basic Conditions of Employment
CNA=Canadian Nurses Association
CAT= Catastrophic Model
CIPD= Charted Institute of Personnel Development
CCMA = Commission for Conciliation Mediation and Arbitration
CSRS=Civil Service Retirement System
DPSA=Department of Public Service and Administration
EAP= Employee Assistance Programme
EFILWC=European Foundation for the Improvement of Living and Working Conditions
FERS=Federal Employees Retirement System
GDoH=Gauteng Department of Health
GHP=Gross Health Product
HRIM=Human Resource Information Management
HRDS=Human Resource Development Strategy
RSA=Republic of South Africa
PILIR=Policy and Procedures on Incapacity Leave for Ill-Health Retirement
PERSAL= Personnel Remuneration Administration System
PSCBC=Public ServiceCo-ordinating Bargaining Council
PTO= Paid Time off Model
PSC= Public Service Commission
SACOB=South African Chamber of Business
V
Table of Contents
1 CHAPTER 1 GENERAL INTRODUCTION 1
11 INTRODUCTION 1
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH 1
13 PROBLEM STATEMENT 2
14 AIM AND OBJECTIVES OF THE RESEARCH 2
141 Aim 2
142 Objectives 2
15 LITERATURE REVIEW 3
16 TERMINOLOGY 3
17 RESEARCH DESIGN AND METHODOLOGY 4
171 Research design 4
172 Methodology 5
173 Unit of analysis 7
174 Unit of observation 7
18 CONSTRUCT VALIDITY 7
19 ETHICAL CONSIDERATION 7
110 LIMITATIONS OF THE RESEARCH 8
111 STRUCTURE OF THE RESEARCH 8
112 REFERENCE TECHNIQUEhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip9
113 CONCLUSION 9
2 CHAPTER 2 MANAGING ABSENTEEISM 10
21 INTRODUCTION 10
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM 10
221 Classification of absenteeism 15
222 Definition of key concepts 15
23 EMPLOYMENT RELATIONSHIPS 17
231 Employment relationship as a multi-dimensional phenomenon 17
2311 Economic dimensions 17
2312 Legal dimension 18
2313 Individual dimension 18
2314 Collective dimension 19
2315 Psycho-social dimension 19
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM 19
25 PREDICTORS OF ABSENTEEISM 20
26 A MULTI-GROUP INVARIANCE MODEL 22
27 CATASTROPHIC MODEL (CAT) 24
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM 24
VI
281 Measuring absenteeism 25
29 IMPACT OF WORKPLACE ABSENTEEISM 25
291 Cost to the institution 26
292 Low productivity 27
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM 27
2101 Effective communication 28
2102 Empowerment of managers 28
2103 Monitoring of workplace absenteeism 29
2104 Visits to facilities 30
2105 Incentive system 30
2106 Team support 31
2107 Return-to-work interviews 31
2108 Employee assistance programme (EAP) 32
2109 Occupational and safety committee 32
21010 Review committeehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip33
211 CONCLUSION 33
3 CHAPTER 3 METHODOLOGY IN RESEARCH 34
31 INTRODUCTION 34
32 RESEARCH DESIGN 34
321 Methodology 34
33 UNIT OF ANALYSIS 36
34 UNIT OF OBSERVATIONS 36
35 CONSTRUCT VALIDITY 36
36 ETHICAL CONSIDERATIONS 37
37 CONCLUSION 37
4 CHAPTER 4 INTERPRETATION AND ANALYSIS OF DATA 38
41 INTRODUCTION 38
42 THE STRUCTURE OF THE ORGANISATION 38
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY 39
44 COMPARISON OF HOSPITALS PERMANENT EMPLOYEES 40
441 The Tara Moross Centre Hospital 46
442 The Germiston Hospital 46
443 The ODI District Hospital 46
444 The George Mukhari Hospital 46
45 RESEARCH INTERPRETATION 47
451 Occupational groups in relation to absenteeism 49
4511 Doctors 50
4512 Professional nurses 51
4513 Staff nurses 51
VII
4514 Nursing assistants 51
4515 Finance officers 52
4516 Administration staff 52
4517 Administration support 52
452 Race in relation to absenteeism 57
4521 Africans 57
4522 Whites 57
4523 Coloureds 57
4524 Indians 58
453 Tenure range in relation to absenteeism 59
454 Salary range in relation to absenteeism 60
455 Age of full time employees in relation to absenteeism 61
456 Gender in relation to absenteeism 63
457 Week days in relation to occupational groups 64
46 CONCLUSION 66
5 CHAPTER 5 FINDINGS CONCLUSIONS AND RECOMMENDATIONS 67
51 INTRODUCTION 67
52 FINDINGS 67
53 CONCLUSIONS 71
54 RECOMMENDATIONS 72
BIBLIOGRAPHY 74
ANNEXURES A B Chelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip82
VIII
LIST OF FIGURES
FIGURE 21 CONCEPTUAL FRAMEWORK MODELhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
FIGURE 22 MODEL SPECIFICATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
FIGURE 41 INTEGRATED ORGANISATIONAL STRUCTUREhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip53
AS REPRESENTED BY THE HOSPITALS
FIGURE 44 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip58
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip60
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip61
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALShelliphelliphelliphelliphellip62
FIGURE 48 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip64
X
LIST OF TABLES
Table 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
Table 2 COMPARISONS OF NUMBERS OF ADMINISTRATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
AND SUPPORT STAFF IN THE DIFFERENT HOSPITALS
Table 3 GENDER COMPARISON IN DIFFERENT HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Table 4 COMPARISON OF TENURE OF SERVICE IN RELATION TOhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
ABSENTEEISM IN THE FOUR HOSPITALS
Table 5 COMPARISON OF THE OCCUPATIONAL GROUPShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip45
IN THE DIFFERENT HOSPITALS
Table 6 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip48
Table 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Table 8 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip54
(SALARY RANGE 1-12)
Table 9 AGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip55
Table 10 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Table 11 WEEK DAYS IN RELATION TO ABSENTEEISM INhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip65
THE FOUR HOSPITALS
Table 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphellip66
IX
CHAPTER 1
GENERAL INTRODUCTION
11 INTRODUCTION
The Gauteng Province is viewed as a province of opportunities by South Africans as well the
neighbouring countries such as Mozambique and Zimbabwe The impact of these
perceptions has placed a heavy demand on services including health provided within the
confines of the province the results being an increase in the workload of the employees
The indirect results of the increase in the workload have been unacceptably high levels of
absenteeism seemingly sub-standard levels of health care and high cost of delivering the
health care services Absenteeism poses a threat and can lead to the collapse of health care
services if absenteeism is poorly managed The research examines the management and
control of absenteeism in four out of thirty four hospitals that service the province The
hospitals that have been targeted for the research are ODI District Hospital Germiston
Hospital TARA Moross Centre Hospital and George Mukhari Hospital
This chapter explains the background and motivation for the research The research
highlights the problem statement which focuses on the effective management of
absenteeism The objectives of the study the research methodology and structure of the
research are explained The relevant literature review was consulted for the research The
key concepts that are used in the research are conceptually defined The research design is
a descriptive stratified random survey The data that were used were collected in three
phases the unit of analysis were the employees of the Gauteng Department of Health in the
four target hospitals and the unit of observations were observations of the employees of
the four hospitals The construct of validity was achieved through using a variety of data
collection methods Ethical considerations were taken into account during the research
process Limitations of the research were imposed by the uniqueness of each of the target
hospitals The structure of the research and the reference technique is explained in this
chapter The research on absenteeism in the Gauteng Department of Health is confined to
the period of 1 January 2008 to 31 December 2008 and focused on the working-man days
lost how absenteeism is managed and employee well-being and rehabilitation
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH
The Gauteng Department of Health received a qualified report in 2008 on the control of sick
leave A performance audit was conducted by the Public Service Commission (PSC) (2002
xvi) into the information required to effectively manage sick leave in the public service
1
The research on absenteeism in Gauteng Department of Health seeks to examine the extent
of workplace absenteeism in the ODI District Hospital which is in a transitional stage from
North West to the Gauteng Province The hospital falls under Tshwane Metropolitan
Municipality and is in Region C The Germiston Hospital falls under Ekurhuleni Metropolitan
Municipality in Region B TARA Moross Centre Hospital is in Region A under the
Johannesburg Metropolitan Municipality and George Mukhari Academic Hospital is Region C
under the Tshwane Metropolitan Municipality The research seeks to examine the degree of
compliance by the four hospitals with the recommendations of the performance audit of
management of sick leave in the light of the qualified report received by the Gauteng
Department of Health (Human Resources) in 20089
13 PROBLEM STATEMENT
The Gauteng Department of Health provides health care services as the core business of the
Department The Health care services are labour intensive and high levels of absenteeism by
its employees undermine the Departmental efforts to deliver quality health care to the
people of Gauteng The problem statement therefore is to examine to what extent the
effective management of absenteeism can enhance the effectiveness of the Gauteng
Department of Health
14 AIM AND OBJECTIVES OF THE RESEARCH
The aim and objectives of the research are explained in this section
141 AIM
The aim of the research is to determine how the effective management of absenteeism can
contribute to the effective health care of Gautengrsquos communities
142 Objectives
The objectives of the study are
to determine the impact of the variables such as age gender occupational category
and salary level on workplace absenteeism
to determine whether the correlation between absenteeism levels and tenure of
service does exist
to determine trends of workplace absenteeism in different employee categories and
to establish the different challenges confronting the different hospitals in
management and control of absenteeism in terms of size complexity and location
2
15 LITERATURE REVIEW
Various studies have been conducted to examine workplace absenteeism in different fields
in government and private institutions Van Der Westhuizen (200636) research focused on
high and low combinations of job involvement and organisational commitment The
outcome was not emphatic on the findings as predictors of the turnover and absenteeism
The research noted that women are more absent from the workplace than men De Wit
(2006) focused on the nature of absenteeism the impact of absenteeism on the
organisation reasons for and causes of absenteeism and measurement of absenteeism and
the findings were not able to find a high coefficient in the test sample
Camp and Lambert (20054) found that the use of sick leave as an incentive to reduce sick
leave by the employees under the Civil Service Retirement System (CSRS) led to a reduction
of absenteeism as a result of sick leave when compared with employees who functioned
under the conditions of the Federal Employees Retirement System (FERS) who within the
same company lost the unused sick leave when they retired
Ferguson Ferguson Muedder and Fitzgerald (200138) focused on the impact of
absenteeism and cost in terms of time lost in the Total Absence Management (TAM)
concept and found that the aging employee exposes institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods of
time
Serneels Lindelow and Lievens (2008210) claim absenteeism is high among employees in
the public sector in developing countries due to a lack of accountability and a lack of
punishment for transgression
The research seeks to determine the extent of the problem of workplace absenteeism its
impact and management in the identified hospitals It seeks to establish the relationship if
any between the various variables and absenteeism such as age occupation tenure salary
level gender and race
16 TERMINOLOGY
Key concepts that are used in the research are conceptually defined however a
comprehensive concept clarification will be done in chapter 2
Workplace absenteeism Workplace absenteeism is the absence of employee at the
workplace that is defined by Du Toit and Van Der Waldt in (1998139) as the place that the
institution makes available and where officials have to perform their work
3
Workplace forms part of the internal environment for public administration in the public
service Robbins Odendaal and Roodt (200415) define absenteeism as the failure of an
employee to report for work as scheduled regardless of the reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work According to
Venter (2003267) desertion occurs when the employee leaves the place of employment
without the intention to return to work
Employee An employee is defined as any person employed in terms of the Public Service
Act 1994 irrespective of rank or position (Public Service Act 1994 Subsection 15) Todd
(20011) refers to an employee as any person excluding an independent contractor who
works for another person and is entitled to be paid for it or who in any manner assists in
carrying on or conduct the business of the employer Bendix (2000123) defines an
employee as a person in a workplace except a ldquosenior managerial employeerdquo whose status
and contract of service grants the employee the authority to represent the employer in
interactions with the workplace forum to determine policy on behalf of the employer and
make decisions which might conflict with representation of workers at the workplace
Employer An employer as an individual person who may be the employer in legal terms as
well as the organisation which is responsible for implementing Public Service human
resource management policies (RSA 1997 Section 15)
Leave cycle The Public Service Act 1994 refers to the leave cycle as 36 months employment
with the same employer
Quality Is defined as getting the best results possible within the available resources (RSA
2011)
Standard Is a statement of an expected level of quality delivery A standard reflects the
ideal performance level of a health establishment in providing quality care (RSA 2011)
17 RESEARCH DESIGN AND METHODOLOGY
This section deals with the research design and methodology
171 Research design
Research design is the overall plan for relating the conceptual problem to relevant empirical
research It is a quantitative descriptive research that involves the systematic collection of
numerical information under conditions of considerable control (Polit amp Hungler 1994
24175)
4
The choice of the research design influences subsequent research activities such as
identifying the target subjects what data to collect and how they should be collected The
research design is a descriptive stratified random survey which is concerned with
characteristics of a specific population subject at a fixed point in time for comparative
purposes The focus is on a representative sample of the relevant population It is concerned
with the accuracy of the findings and their generalisability The survey is used to gain deeper
insight of the behaviour of employees with regards to motivation satisfaction and
grievances (Babbie 199289 Ghauri Gronhaug amp Kristianslund 199527 60 Brink 199611
6 Welman Kruger amp Mitchell 200152)
172 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services Four hospitals of the thirty four health care delivery institutions have been
identified for the research
Each hospital is unique in its character in terms of specialisation of health care delivery
service The four hospitals are located in Tshwane Johannesburg and Ekurhuleni
Metropolitan Municipalities The sample is a stratified random sampling which is composed
of various clearly recognisable non-overlapping sub-populations (strata) that differ from
one another mutually in terms of variables that are a combination of more than one
variable such as age sex income level or educational level The purpose is to ensure that
every part of the population (every stratum) is represented The members of a particular
stratum are homogeneous in the population at large The sample is representative of a
population with clearly distinguishable strata with a greater degree of certainty (Babbie
199267 Brynard amp Hanekom 200544 Ghauri et al 199578 Brink 1996138 Welman amp
Kruger 200155-56 Welman et al 201061 Polit and Hungler 199518) The data were
collected in three phases
The first phase of data collection was done through auditing of hard copies of identified
personnel files representing ten files per hospital and using the tool in annexure A amp B The
forty employeesrsquo profiles were accessed through the Human Resource Information
Management system (HRIM) located in the Gauteng Department of Health Head Office The
respective employeesrsquo profiles were handed over to the human resource manager in the
respective hospitals on the morning of the audit for the human resource practitioner to
draw out the hard copy files for auditing The characteristics of the individuals that were
identified for the first phase were males and females and the different race groups The
auditing of the files was for the complete working life of the employees and not confined to
2008 only Registers that are used by the human resource administration to control the
movement of the leave forms were inspected as evidence of the control system in place
5
The purpose of auditing the files is to gain insight into how leave in general was captured
managed and controlled by the hospitals The second phase of data collection was done
through structured interviews with the four human resource managers who were directly
accountable for management and control of leave of absence in general in the four
hospitals
A structured interview provides for a more organised approach and a more stable basis for
assessment of the different candidates (Erasmus Swanepoel Schenk Van der Westhuizen amp
Wessels 2005250) The structured interview was conducted using the tool in annexure C
Tara Moross Centre Hospital had been functioning without a manager in human resource
and the manager that was interviewed had been in the post for three months The human
resource practitioner who was at salary level 8 acting in the Assistant Directorrsquos post
(manager) was invited to join the manager and be part of the structured interview ODI
District Hospital had three human resource practitioners including the accounting officer at
level 8 and in an acting capacity
The third phase of data collection was through the Human Resource Information
Management (HRIM) This system used Personnel Remuneration Administration System
(PERSAL) to collect data Data in this system are categorised in salary level date of
appointment occupational category gender age in units of five race employing hospital
employment status in different categories such as session contract and full-time and the
different types of leave of absence
The research used primary and secondary data in analysing sick leave utilised by full time
employees in the identified hospitals for the period of 1 January to 31 December 2008 using
the Personnel Remuneration Administration System The total population sample was four
thousands and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range at level 1 to 12
The research used past events such as sick leave utilised by employees using secondary
data from Personnel Remuneration Administration System falling into the category of a
historical empirical research The interval scale of measurement was used in the
quantitative research and actual numbers are ordered with equal measurement between
each category (Brink 1996 149 Brynard amp Hanekom 2005 28-29 Mouton 2005
52100170)
6
173 Unit of analysis
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the research refers to observation of work attendance by
the employees of Gauteng Department of Health in the four hospitals
The observation deals with the historical events such as employees who have already
utilised sick leave in the workplace The subjects that are studied are the core health care
providers such as doctors nurses and support employees such as allied administration and
administration support (Mouton 200551-52 Welman et al 2001 52-53)
174 Unit of observations
The observations that are made are of health care workers and support teams in Tara
Hospital Germiston Hospital ODI Hospital and George Mukhari Hospitals The unit of
observations describes the characteristics of a large number of individual people such as
gender age salary range occupational category tenure of service and race in relation to
absenteeism in the workplace In the descriptive research the individual characteristics are
aggregated for the purpose of describing a larger group (Babbie 199292)
18 CONSTRUCT VALIDITY
Construct validity is concerned with the question what construct is the instrument actually
measuring(Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with the four accounting officers in leave management The third phase was collecting of
personnel data through the Persal system
19 ETHICAL CONSIDERATIONS
Ethical considerations included among other issues the protection of the unit of analysis and
unit of observations from discomfort and harm by not revealing information which can
cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity Anonymity is achieved
when the researcher cannot link a given response with a given respondent and reporting
aggregate data only When data are collected at one sitting and not over a period of time
makes it possible to achieve anonymity as the need for follow up is eliminated Subjects of
observations are selected for reasons directly related to the problem being studied as the
principle of justice
7
Confidentiality is about the researcherrsquos responsibility to protect all data gathered within
the scope of the research and shared only with people involved in the research (Babbie
1992465ndash466 Brink 199640ndash41 45)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous The interview was part of the actual audit
that was done as part of monitoring and evaluation that was in progress in the Department
of Health following a negative auditor generalrsquos report about management of leave in
general The managers were put at ease as they were given the check list afterwards for
self-monitoring for future self-auditing
The data that were collected through Personnel Remuneration Administration System
(Persal) identified employees through the Persal number and kept their identity anonymous
The data that were collected through the hard copy of employeesrsquo files were used to point
out areas of concern to the managers and the files did not leave the office of the manager
at the end of the process once more protecting the identity of the employee
110 LIMITATIONS OF THE RESEARCH
The research was conducted on four hospitals of different sizes specialisation and three
metropolitans with unique challenges The period of the research was confined to a
calendar year (2008) and not a financial year The focus was on absenteeism due to sick
leave of full time employees There is no distinction that is drawn between the working-man
days that are lost between shift and non-shift workers The findings may be different if all
absenteeism of employees at the time were considered for the research
111 STRUCTURE OF THE RESEARCH
Chapter 1 It provides a general introduction to the research It includes an introduction the
background and motivation for the research that provides the context the problem
statement and the significance of the research The key concepts are defined The research
design the method of data collection the sampling method data analysis and
interpretation limitations to the research are explained in this chapter
Chapter 2 This chapter considers the theoretical foundations concepts characteristics
theories approaches and classifications of workplace absenteeism Conceptual framework
of absenteeism predictors of absenteeism and various models of absenteeism are
explained Measures to control workplace absenteeism the impact of absenteeism in the
institution and management intervention strategies are explained
Chapter 3 It describes the research design different aspects of the research methods
applied and the data collection techniques used unit of analysis units of observations
construct validity and ethical considerations
8
Chapter 4 This chapter provides the organisational structure of the Gauteng Department of
Health comparisons of hospital employees different race groups of the four hospitals
gender comparisons in different hospitals and comparisons of the different occupational
groups It provides a short description of the target hospitals The research interpretation is
discussed in terms of the different occupational groups and absenteeism different races
and absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism
The week days absenteeism pattern and contributions by the four hospitals to absenteeism
are presented in this chapter
Chapter 5 It provides a discussion of the research evaluation of workplace absenteeism
findings recommendations and limitations
112 REFERENCE TECHNIQUE
The reference technique that is applied in the research involves all sources that have been
consulted while doing the research When legislation is used as a source of information
reference to the specific act is used
113 CONCLUSION
Chapter 1 provides a discussion on the background and motivation of the research problem
statement and the objectives The significance of the research in South African public
institutions and private institutions of other countries and the possible contribution of the
study are explored The terminology that is used in the research is contextualised for the
purpose of the research The research design and methodology are presented in this
chapter The units of analysis the units of observation construct validity ethical
considerations and limitations to the research are also presented in this chapter
The next chapter discusses the theories of absenteeism
9
CHAPTER 2
MANAGING ABSENTEEISM
21 INTRODUCTION
The Gauteng Department of Health is classified as a public institution whose existence is
justified on the grounds that it renders health care services to the public The health care
system is encouraged to develop delivery systems and practices that are in line with
international standards management practices that promote efficient and compassionate
delivery of services and ensures respect for human rights and accountability to the public
(African National Congress 199443-44) This objective can only be achieved if the resources
to provide such services are available The human resources are a vital factor for the health
care sector as it is labour intensive Public institutions such as the Gauteng Department of
Health are funded from public funds and if the human resources do not report for work
service delivery is compromised and the cost to the department in the form of salary
expenditure becomes exorbitant as the department must find replacement staff and pay
for overtime as well It is when all these factors are taken into consideration that workplace
absenteeism becomes a cause for concern for the Gauteng Department of Health
In this chapter absenteeism is discussed from a theoretical perspective and informed by
literature review The classification of workplace absenteeism theoretical perspective
definitions dimensions of employment relationship conceptual framework of absenteeism
structural model of absenteeism legislative framework that regulates the employment
relationship and intervention strategies to control workplace absenteeism are explored
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM
According to Viviane (20111) the term absenteeism was first used in Britain during the
First World War in dealing with employed persons It is during the times when production is
of pressing national importance that the absence of employees from the workplace is keenly
felt Absenteeism is considered a good barometer of staff morale an indirect measure of
employeesrsquo health and well-being and is found to be associated with health-related
absences from work Employees who are motivated and committed to their work and
employer have to be very sick before they book off sick (Griep Rotenberg Chor Toivanen amp
Landsbergis 2010179)
McCormick and Ilgen (198556-57) describe job attendance criteria as relating to a tendency
of employees to withdraw from or attend to their jobs The criteria identified were job
tenure occupational category absenteeism and tardiness According to Markussen
Rogeberg and Gaure (20096) employee characteristics such as age gender education and
occupation have a substantial impact on absence behaviour
10
Chaudhury and Hammer (20033) identified that medical skills and nursing skills are
marketable and greatly in demand Doctors and nurses used this opportunity to make
money and work as private health care providers as well as public health care providers
holding two jobs The absence is considered in terms of morning or afternoon absence by
these categories as they are viewed as having a great deal of discretion over where and
when to discharge their public responsibilities The criteria identified were job tenure
absenteeism and tardiness
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) refer to absenteeism
as non-attendance when an employee is scheduled to work The theoretical perspective of
absenteeism takes into account the physical and or psychological absence of the employee
from the workplace or work station at a time when the employee is contractually expected
to be at the workplace According to Andrews (199734-35) the behaviour and actions of
public officials are determined by specific ethical codes of conduct and it is assumed that
their actions are for the benefit of the communities that are serviced by the public officials
Social ethics focus on how the clients of the Department are treated and are therefore
concerned with the impact of decisions on people inside and outside the institution
individually and collectively
Grogan (2005237) states that employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
look for trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
2001 section F(c) In the public sector contractual employee benefits are modified by
collective agreements These benefits are material gains for the employees and have a
monetary value and a cost factor to the employer
The contract of employment often includes insured benefits such as incapacity ill health
and early retirement as the total package other than the remuneration for the time worked
as it is intended to attract retain and motivate employees (Breetzke 20091 Ferguson et al
200137 LexisNexis 2006670 LexisNexis 2007176 Markussen Rogeberg amp Gaure 20093
Tustin 199452) The policy on Determination on Leave of Absence requires a medical
certificate for sick leave of three or more days and for every sick leave day utilised when the
eight week rule has been transgressed (DPSA 2009 Section 14 subsection 147)
Political ideologies influence the work environment resulting in some areas being highly
unionised where unions are perceived to be capable of exerting control over the employer
and employee relations for the primary benefit of the employees
11
It is the work environment which is highly unionised that is characterised by high workplace
absenteeism (Andrews 199736 Breetzke 20091 Du Toit amp Van Der Waldt 1998170139
Tustin 199452) Allen (1984331) claims that union members might be absent more
frequently from the workplace than non-members because they face smaller penalties for
absenteeism According to Markussen et al (20095 21) workplace environments do have an
impact on absenteeism and are influenced by social interaction processes among
colleagues Absenteeism is affected by social norms Workplaces with high employee
turnover rate tend to have high absenteeism The turnover rate is defined on a quarterly
basis as Min (number of entries number of existing persons) divided by the number of
employees at the start of the quarter The Charted Institute of Personnel and Development
(CIPD) (200811) claim that the 2006 survey of absence management portrays the public
sector employees as less likely to be dismissed for reasons of workplace absenteeism A
report by the National Institute of Labour Studies (Tonya 20011) found the rate of
absenteeism increased among full-time employees from 2 4 to 25 within two years
The services that are provided by the Department of Health are divided into two distinct
categories Direct services are those services that are rendered to the clients who are
patients who receive medical treatment from the core employees usually referred to as line
functionaries Direct services can only become effective and efficient when supported by
the services of the support staff that provide indirect health care services When employees
do not present themselves for work when scheduled to work and do so on a regular basis
the situation becomes habitual absenteeism (Du Toit amp Van Der Waldt 199818) The
Gauteng Department of Healthrsquos core function is to provide health care services to the
people of Gauteng Province The provision of health care services is labour intensive and
requires large numbers of personnel for effective service delivery
The workplace which may be physical or virtual for the public service employees represent
the internal environment of the institution The employer who is represented by the
manager determines the workplace for employees
Rogers and Hertin (1993217) explain the Decision Model Theory as a conscious decision by
the employee to stay away from work or come to work based on which motivation is
stronger at that moment It is not based on the ability to come to work
Serneels et al (2008210) claim that absenteeism is rife in the public sector especially where
employees hold two jobs The actions of public officials in the performance of their duties
should be ethically justified as it impacts on the decisions of people within and without the
institution individually and collectively Tension and job insecurity in the workplace
manifests as absenteeism (Andrews 199733-137)
12
Frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased staff
morale and high cost to health care (Davey amp Cummings 2009312-313) It is suggested that
on average health care workers are likely to be absent from work as a result of illness or
injury rather than other occupations Dagmara (20002) states that absenteeism may be a
benchmark of what is happening in the hospital setting Absenteeism is defined as habitually
not coming to work when scheduled to It is an indicator of psychological medical or social
adjustment to work
Absenteeism is measured by frequency or duration of work-days missed Frequency
measures provide a reasonable index of voluntary absenteeism whereby each incidence or
episode of absence is counted regardless of the duration of absence It is defined as the
number of days absent over a given period of time Other measures used were total days
duration and percentage Duration measures provide an index of involuntary absenteeism
such as time lost index To assess absence duration the total number of days is tallied
regardless of the number of incidents (Davey amp Cummings 2009313) High workload is
identified as one of the factors that affect absenteeism rate among health care workers
(Oi-ling 20023)
Workplace absenteeism is costly for an institution in terms of lost working-man days hiring
of staff to close the shortage absent or sub-standard service delivery and poor quality of
services The total cost of employment risk approach is about the estimation of the possible
cost of any absent employee to an institution per hour The annual cost to the institutions
per employee is in terms of direct and indirect costs such as overtime low productivity and
a decline in morale among workers who are expected to cover for an absent employee
(Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
The public service employees enjoy security of tenure which may be a contributory factor
of absence from work without good cause This practice is fostered by the knowledge that
they cannot be easily dismissed from their jobs therefore have the belief it is right to stay
away from work Misuse of sick leave is considered to be an overriding problem in instances
where the employee does not uphold the standard of honesty and incorruptibility or these
values are not considered to be the corporate values and norms of the institution (Andrews
1997 221-222 MINTRAC 20093)
Bangali (20043-5) describes age function in the sociological theory as a natural
characteristic of human beings but also an integral aspect belonging to the structure of the
society The age definition in the labour market is influenced by the structural functionalism
The employees age is categorised in the workplace in terms of functions to be performed
be it physical or intellectual The age group of 35 years to 49 years old employees comprise
the largest age group in the labour market
13
The employees who are less than 20 years of age reflect the highest absenteeism rate while
employees above 50 years of age reflect a decrease in the absenteeism rate The
disadvantage of the older workers is that their disabilities last longer once they are injured
and are more likely to be absent as frequently and more likely to be injured than younger
workers Keese (20062) states that ageism is evident in the public service and describes the
age group 25 years to 49 years old as prime age Rogers and Hertin (1993219) found a
significant correlation between the use of sick leave and age Employees with advanced age
used comparatively more sick leave in comparison with the younger employees The
Canadian Nurses Association (20065) noted a reduction in workplace absenteeism rate
among nurses who are less than 45 years of age and an increase in the absenteeism rate
among nurses above 55 years of age
Camp and Lambert (20054) found that the use of sick leave retention as an incentive to
reduce use of sick leave by the employees under the Civil Service Retirement System (CSRS)
leads to a reduction of absenteeism as a result of sick leave compared to the Federal
Employees Retirement System (FERS) who within the same company lost the unused sick
leave when they retired The Employees Retirement System (FERS) applies the same
principle of handling sick leave as the Gauteng Department of Health in the sense that
unused sick leave is forfeited at the end of the three year cycle (DPSA 2009Section 14)
Unruh and Strickland (2007674) found that absenteeism from the workplace does
contribute to a vicious cycle of a negative work environment which leads to more
absenteeism and increased turnover Absenteeism has been found to be higher in
employees who are over 50 years of age and the phenomenon is attributed to age and
changing abilities that increase when work is performed on a full time basis Part-time
arrangements reduce absenteeism as well as the cost of paying for a senior employee even
if seniority is just in tenure Age has been linked to a negative turnover in an institution The
older employee is less likely to leave the organisation An institution is healthier for a spread
of ages Some organisations consider employees to be older in batches or cohorts of five
such as 40 years to 44 years up to 64 years (Nichols amp Evangelisti 2001285 McGoldrick amp
Arrowsmith 200184 MINTRAC 20093 Reday-Mulvey 200579-194)
MINTRAC (20094-8) states that gender moderates the age turnover relationship Women
are more likely to remain in their jobs the older they get than men do Turnover is
occasionally related or preceded by high workplace absenteeism The occupational category
is linked to skill levels and salary levels The lower skill employees are concentrated in the
lower skill occupations and easily replaceable
14
Hirschfield Schmitt and Bedeian (2002553) conducted a research on low-wage public
sector clerical employees and found that those employees who perceived limited
performance-reward expectancies were likely to be absent more often The link between
skilled employees and absenteeism suggested that employees may have utilised
absenteeism as a means of compensating for perceived workplace contributions not
extrinsically rewarded
According to Gaudine and Gregory (2010599) the Canadian Institute for Health Information
(2007) found that absenteeism was a problem among health care workers in comparison to
other employees in other sectors Unruh et al (2007673) found the combination of high
registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery Markussen et al (200921) claim that the type of occupation an
employee is engaged in has an impact on absenteeism
221 Classification of absenteeism
The employees of the Gauteng province and their attendance at work are the focal point of
the province in relation to service delivery that is customer focused Health care services are
labour intensive and require employees to be at work when scheduled to do so (Gauteng
Province 201015) Workplace absenteeism can present in different forms and levels as a
result of a combination of variables (Andrews 19975 Breetzke 20091) McCormick and
Ilgen (198557) and Davey and Cummings (2009313) classify absenteeism as voluntary
when the absence is based on the conscious decision by the health care giver to withhold
contractual services The absence is uncertified unauthorised and unexcused while
involuntary absenteeism occurs for reasons beyond the control of the health care giver
such as illness injury or family responsibility Employers are challenged with the task of
differentiating between the absence due to elective workplace absence and absence due to
illness incapacity The differentiation is based on whether the illness incapacity is validated
by a legitimate medical certificate in terms of the prescript of section 23 of the Basic
Conditions of Employment Act (BCEA) 75 of 1997 (RSA 1997)
222 Definition of key concepts
Concepts are defined for common understanding in the context of the study
Workplace absenteeism Workplace absenteeism is absence of the employee at the
workplace that is defined by Du Toit and Van Der Waldt (1998139) as the place that the
institution makes available and where officials have to perform their work It forms part of
the internal environment for public administration in the public service Bamford Klein and
Engelbrecht (199911) refer to absenteeism as employees taking time off that has not been
scheduled
15
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) claim that
absenteeism is non-attendance when an employee is scheduled to work The European
Foundation (199711) views absenteeism as temporary or permanent incapacity for work as
a result of sickness or infirmity According to Robbins Odendaal amp Roodt (200415)
absenteeism is a failure of an employee to report for work as scheduled regardless of the
reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work The employee
should actually intimate expressly or by implication the intention not to return to work
According to Venter (2003267) desertion occurs when the employee leaves the place of
employment without the intention to return to work
Employee The Basic Conditions of Employment Act no 75 of 1997 Section 1 (a) (RSA 1997)
and Todd (20011) refers to an employee as any person excluding an independent
contractor who works for another person and is entitled to be paid for it or who in any
manner assists in carrying on or conduct the business of the employer The courts use the
control test which identified employees on the basis that they were part of the employer
organisation Bendix (2000123) claims that an employee is a person in a workplace except a
senior managerial employee whose status and contract of service grants the employee the
authority to represent the employer in interactions with the workplace forum to determine
policy on behalf of the employer and make decisions which might conflict with
representation of employees at the workplace Du Toit Bosch Woolfrey Godfrey Rossouw
Christie Cooper Giles and Bosch (200368) state that an employee is a person who works
for a single employer in a permanent fulltime capacity is subject to the supervision of the
employer and receives regular monthly or weekly remuneration and is obliged during
working hours to place his or her productive capacity at the employerrsquos prescribed disposal
Employer
Bendix (2000129) defines an employer as any person except an independent contractor
working for another person or the State and who receives remuneration or any manner
assists in carrying out or conducting the business of an employer DPSA (PILIR) (20094)
states that an employer is the Head of Department or a designated office which will be
responsible for the handling and investigation of incapacity leave applications and ill- health
retirement applications
16
23 EMPLOYMENT RELATIONSHIPS
The employment relationship is about balancing the simultaneous convergent and divergent
interests of the employer and the employee in a regulated manner with the aim of getting
the work of the institution done According to Erasmus et al (2005442) an employment
relationship exists when an individual is employed by someone else to be available to work
for that person in exchange for some remuneration It is through this employment
relationship that reciprocal rights and obligations are created between the employer and
the employee The employment relationship is conflictual in nature (Andrews 199736) The
employees through this relationship are enabled to gain access to the rights and benefits
associated with their employment The Labour Relations Act no 66 of 1995 (RSA 1995)
regulates the management of the conflict in the employment relationship through dispute
resolution structures such as the Commission for Conciliation Mediation and Arbitration
(CCMA) Labour Court and Labour Appeal Court when internal processes fail to resolve the
conflict The employment relationship can be traditional or typical and terms and conditions
of service of employment are regulated by collective agreements This is a tacit
acknowledgement of the existence of a typical employment relation
231 Employment relationship as a multi-dimensional phenomenon
Industrial relations and human resource management are bound together by the
employment relationship through labour employer and industrial relation triangle The
employment relationship is characterised by various dimensions as is the case in a broader
society The dimensions are economic legal individual collective and psycho-social (Grogan
200347)
2311 Economic dimensions
The economic dimension arises through the provision of labour by the employee in the form
of skill knowledge energy abilities and productive time to the employer in exchange for
remuneration Barker (200779) states that a reduction in working hours increases the
hourly cost of production in a unit unless there is a commensurate increase in productivity
The economic dimension is highly regulated The contract of employment includes insured
benefits such as incapacity ill health and early retirement The tendering of services by the
employees is a prerequisite to the employeersquos right to claim remuneration (Grogan
200347) According to LexisNexis (2007176) and the Public Service Regulations 2001
Section E E1 the actual contractual benefits are modified by collective agreements in the
public service sector Employee benefits are material gains for employees that have
monetary value and are a cost factor to the employer The Public Service Regulation 2001
Section F (a) states that the Head of Department shall promote economic and efficient use
of resource to improve the functioning of the public service (RSA 2001)
17
According to Ferguson et al (200137) and Erasmus et al (2005380) employee benefits are
the total compensation package other than the pay for time worked offered to employees
either partially or completely funded by the employer contributions In 2006 about R19
billion was lost on account of absenteeism from sick leave (LexisNexis 2006670 Patrick
2001 17)
Employee benefits are intended to attract retain and motivate employees Some of the
benefits offered to employees are mandated by law such as minimum leave provision as
contained in the Basic Conditions of Employment Act 75 of 1997 and Resolution 72000 of
the Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
2312 Legal dimension
The Labour Relations Act 66 of 1995 Section 3 of Schedule 8 requires that while employees
should be protected from arbitrary action employers are entitled to satisfactory conduct
and work performance from their employees The legal framework provides for the
regulatory requirements for human resource management in the working environment
Grogan (200347) and Grogan (2005120) view the employment relationship as formalised
by a legally binding agreement which is the contract The contract is regulated by specific
laws and formal rules with all the inherent rights and responsibilities to the employer and
the employee In terms of the employment contract one of the responsibilities of the
employee is to render service to the employer at specified agreed upon time except where
the employer has authorised the absence of the employee from the workplace Employees
have a fundamental duty to render services and the employer has a right to expect the
employees to tender such services A basic element of the duty to render service is that the
employee must be at the workplace at the specified agreed upon times unless there is
adequate reason to be absent Bendix (2000120) states that a contract is subject to the
terms and conditions of collective agreements The contract is subject to automatic changes
whenever a new collective agreement is in place The contract and its inherent benefits are
breached by elective absence behaviour of the employee The legal dimension has an
impact on the individual dimension
2313 Individual dimension
The employee enters into a working contract with the employer on an individual basis The
contents of the contract are subject to the Basic Conditions of the Employment Act 75 of
1997 The terms and conditions of employment in the public service are subject to collective
bargaining and collective agreements which influence the employment contract in the
Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
18
The contract of employment is entered into between the employer and the employee under
the supervision of the employer and for remuneration purposes
2314 Collective dimension
According to Slabbert and Swanepoel (20017) the collective dimension of the employment
relationship refers to the organised group aspect of the employment relationship which is
between labour as a group and employers and or their representative public sector
institutions The collective dimension aspect of employment relationship pertains to
legislation relating to bargaining dispute resolution and industrial action
2315 Psycho-social dimension
The psycho-social dimension of the employment relationship represents the unexpressed
needs and expectations of the employer and employees It refers to behaviour in the public
sector institutions within the context of the collective dimension (Davey amp Cumming 2009
313 Erasmus et al (2005442) The Public Service Regulation 2001 Section B states that the
Head of Department shall determine the working time of employees and take into
consideration their personal circumstances which have a social dimension (RSA 2001)
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM
Davey and Cummings (2009322) amalgamated two theories to create a theoretical
framework with the premise that employee attendance is based on two factors the ability
to attend and motivation to attend The theoretical framework focuses on individual work
ethics demographics and from the work environment Some form of absenteeism may be
difficult to prove in a situation where the employer has two or more operational stations or
the employee occasionally operates from a virtual office The duty to render service is
breached by the employee when the employee is physically present and mentally absent as
would be the case of sleeping on duty Workplace absenteeism is multi-dimensional such as
changes in the work environment that overburden the coping mechanism As a result of this
approach a multi-dimensional framework of absenteeism clouds the causative factors of
absenteeism (Breetzke 20091 Patrick 200124 Tustin 199452)
19
FIGURE 21 CONCEPTUAL FRAMEWORK MODEL
(Adapted from Davey amp Cummings 2009320)
The conceptual model uses individual predictors of absenteeism such as age salary level
tenure race gender occupation educational level job satisfaction and organisational
commitment ability to attend and pressure to attend Organisational commitment is
described as having loyalty to the organisation identifying with its core values and
influences whether or not an employee feels it is appropriate to take unauthorised
unscheduled absences Group level absenteeism is not viewed as a predictor of individual
absenteeism (Davey amp Cummings 2009320 Lambert Camp Edward amp Saylor 20058-9)
25 PREDICTORS OF ABSENTEEISM
Oi-ling (20023-6) claims that in Hong Kong there were 47500 work days lost as a result of
employee sick leave in 1998 and suggests the examining of stress levels for nurses in
different cultures to enable a fuller understanding of the predictors of absenteeism as
different cultures accept some predictors and some reject the same reasons for illness
20
Personal characteristics
2Employee value Job
expectation
1Job situation scopejob level role
stress work amp group size leadership
style
4 Satisfaction
with job situation
3 Ability to attend Illness and accidents transport problems
6 Attendance motivation
7 Employee
attendance
5 Pressure to attend work
incentiveswork ethics
Education
salary
tenure age
gender race
Occupation
Lambert et al (20058) claim that organisational commitment job satisfaction job stress
health issues and personal characteristics correlate as regards employee absenteeism The
findings of the research by Van Der Westhuizen (2006136) focused on high and low
combination of job involvement and organisational commitment and the outcome was
emphatic on the turnover as predictor of absenteeism
According to Unruh and Strickland (2007674) absenteeism from the workplace contributes
to a vicious cycle of a negative work environment which leads to more absenteeism and
increased turnover McCormick and Ilgen (198556) describe turnover as dysfunctional
where an employee wishes to leave the institution and the employer prefers to retain the
individual and is functional where the employee wishes to leave the institution and the
employer accepts the termination of services by the employee
De Wit (2006) focused on attitudes towards job factors that had an influence on
absenteeism and was not able to find a high coefficient in the test sample McGoldrick and
Arrowsmith (20018) claim that an organisation is healthier for a spread of ages Ferguson et
al (200138) state that aging employees expose organisations to high levels of absenteeism
through higher probabilities of becoming disabled for longer periods
Oi-ling (20023-6) and Patrick (200124) found that gender and age among other predictors
of absenteeism have a significant influence on absenteeism Age was positively related to
well-being in managers and negatively related to absence frequency among hospital
employees Older employees were shown to have higher responsibility at work and utilised
minimal days for sick leave Female employees were observed to have utilised more
absences than males
Andrews (1997221-222) and MINTRAC (20093-8) state that gender moderates the age
turnover relationship Women are more likely to remain in their jobs the older they get than
men do Turnover is occasionally related or preceded by high workplace absenteeism The
occupational category is linked to skill levels and salary levels The lower skill employees are
concentrated in the lower skill occupations and easily replaceable Public service employees
enjoy security of tenure which maybe a contributory cause of absence from work without
good cause a practice that is encouraged by the knowledge that they cannot be easily
dismissed from their jobs therefore have the belief it is right to stay away from work
Rogers and Hertin (1993217-222) found a correlation between the use of sick leave and
age Employees with advanced age comparatively used more sick leave in comparison with
younger employees The level of education seems to have influenced the use of sick leave
where the lower level categories of employees were found to have a higher level of
absenteeism than higher educated individuals
21
Robbins et al (200447) state that married women employees have fewer absences and
undergo fewer job turnovers Rogers and Hertin (1993222) express tenure as work
experience in years that is viewed as a predictor of employee productivity where seniority
has been found to be inversely related to absenteeism in terms of frequency and total
number of work-man days lost The level of education was found to have an influence
where the lower category of employees was found to have higher levels of absenteeism
than higher educated employees Jacobs and Roodt (2011425) and Davey and Cummings
(2009320) state that an organisational culture in hospitals can contribute towards lower
turnover as the turnover rate is a predictor of absenteeism The process can be facilitated
by promoting knowledge sharing that can provide opportunities that may meet employee
expectations
Pousette and Hanse (2002229-231) suggest that theories that make predictions about
antecedents to ill health and sickness absence make the assumption that the relationships
are the same in different occupations Reduced job autonomy is suggested to be associated
with higher sickness absence The occupation specific model is used in order to identify the
variance in the patterns in terms of occupation-groups Davey and Cummings (2009320)
found that turnover was significantly related to absenteeism
Hirschfield et al (2002553) conducted a research on low-wage public sector clerical
employees and found that those employees who perceived limited performance-reward
expectancies were likely to be absent more often The link between skilled employees and
absenteeism suggested that employees may have utilised absenteeism as a means of
compensating for perceived workplace contributions not extrinsically rewarded Unruh et al
(2007674) found that absenteeism from the workplace does contribute to a vicious cycle of
a negative work environment which leads to more absenteeism and increased turnover
26 A MULTI-GROUP INVARIANCE MODEL
A multi-group invariance structural model represents different types of occupations such as
industrial blue-collar workers industrial collar workers elderly care workers and child
health care workers The focus of this model relates to the extent to which a model that is
assumed to include a general population also includes sub-populations such as different
occupational types The occupation specific model allows different relationships between
variables in different occupations The specific model approach allows for identification of
the most common reasons for absenteeism and early retirement in the workplace and was
successfully utilised in Sweden A common model proposes that absenteeism is a
behavioural response to dissatisfaction with the job (Pousette amp Hanse 2002230-244)
Nyathi (200059) found that professional nurses were absent from work because they
wanted to prolong their weekends
22
Davey and Cummings (2009313) argue that on average health care employees are more
likely to be absent from work as a result of illness or injury than other occupations Paton
(20104) acknowledges that line managers are the fundamental building blocks for reducing
absenteeism and must be provided with the tools to manage absence The absence rate at
3 is considered very high and must be vigorously and progressively managed
FIGURE 22 MODEL SPECIFICATION
(Adapted from Pousette amp Hanse 2002232)
Pousette and Hanse (2002232-245) make the assumption that low job autonomy and low
skill discretion deprive the employees of the opportunity to handle work obstacles and
regulate workload to a manageable level implying a negative relationship to workload has
an impact on absenteeism rate Patrick (200123-24) states that changes in the working
conditions overburden the coping mechanism Work-related stress can lead to deteriorating
physical and emotional well-being The work object is the distinguishing quality between
occupations in the different occupational groups whereby the blue-collar employee works
with things that are tangible such as materials and machines whereas the white-collar
employee is knowledge based employee who is working with data
23
Structural Model
W L Work load
I H Ill-Health
S A Sickness absenteeism
S D Skills discretion
(autonomy)
27 CATASTROPHIC MODEL (CAT)
According to Buschak Craven and Ledman (199628) the catastrophic model (CAT) caters for
major illness that keeps the employee away from work for extended periods of time This
model is similar to short and long term incapacity sick leave whereby the employee has
exhausted the normal sick leave of 36 days which is catered for by DPSA section 14 (RSA
2009)
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM
The general behaviour and actions of public officials are determined by specific ethical
codes of conduct and the unethical conduct results in effective administration and
unsatisfactory service delivery (Andrews 199733) Effective control of workplace
absenteeism requires an absenteeism policy to be in place management to establish the
magnitude and patterns of absenteeism and raise awareness about the consequences of
breaking these rules (Bamford Klein amp Engelbrecht 19992)
The Determination on Leave of Absence in the Public Service (DPSA 2009 section 14 141)
the Public Service Co-ordinating Bargaining Council Resolution (PSCBC 72000) Davey and
Cummings (2009313) and DPSA (PILIR) 2009 section 3 31 state that an employee is
entitled to 36 working days sick leave with full pay in a three year cycle with the same
employer Any unused leave credits shall lapse at the end of the three year cycle The
employee is expected to utilise and manage the normal leave circumspectly The employee
who chooses to utilise sick leave days must submit a medical certificate for every occasion
of three or more sick leave days utilised The medical certificate must be issued and signed
by a practitioner or persons who are registered with the Professional Councils established
by the Act of Parliament Incapacity leave is additional sick leave granted conditionally at the
employerrsquos discretion An employee who has exhausted the normal sick leave during the
prescribed sick leave cycle and who requires to be absent from work due to a temporary
incapacity may apply for temporary incapacity leave with full pay According to the Policy
and Procedures on Incapacity Leave for Ill-Health Retirement (PILIR) (DPSA 2009) an
employer is not required to pay an employee if the employee has been absent from work
for more than two consecutive days or more than two occasions during an eight week
period and on request does not produce a medical certificate
The Public Service Regulations 2001 F (c) holds the manager accountable when an
employee abuses sick leave (RSA 2001) According to Parbhoo (20036) and Nel et al
(2008145) the doctor patient confidentiality is not above reach to the employment
relationship by suggesting that the employer can question the authenticity or contents of
the medical certificate if there is sufficient reason to do so within the confines of
confidentiality
24
According to Breetzke (20092) South African employees are challenged by global trends to
seek mechanisms to deal with excessive absenteeism at the workplace The Charted
Institute of Personnel and Development (CIPD) (200811) claims that the 2006 survey
showed that public sector employees are less likely to be disciplined or dismissed for
reasons of workplace absenteeism
281 Measuring absenteeism
Measuring absenteeism in the workplace enables the employer to determine the extent and
nature of the problem Absenteeism is measured using two measures total time lost and
absence frequency Nel et al (2001584) In institutions total time lost is determined for
every group of employees and category of absence such as sick absence authorised and
unauthorised absence The recognised international norm is 3 Institutions challenged
whether to accept the international norm as the given or strive to bring workplace
absenteeism down in the interest of quality and quantity of service delivery The total time
lost index is calculated as the Total number of days lost due to absence over the period
multiplied by a thousand and divided by the average number of employees multiplied by a
thousand and divided by an average number of employees multiplied by total work-days
over the period (Amin Das amp Goldstein 20086 Breetzke 20094 Nel et al (2001584)
According to Nel et al (2001584) high workplace absenteeism rate is suggestive of incidence
that is of short duration and therefore more disruptive to the operational plans of an
institution as prior knowledge of pending workplace absenteeism allows for forward
planning and reduction of the costs associated with absenteeism The absence frequency
rate is calculated as Number of absence incidence over the period divided by the average
number of employees employed over the period (Breetzke 20094 Nel et al 2001254)
29 IMPACT OF WORKPLACE ABSENTEEISM
Lambert et al (20056 36) claim that absenteeism has adverse effects on those employees
who are good attenders as they are shuffled around to fill in the positions of absent
employees Organisations suffer the detrimental effects and consequences of employee
absenteeism Management expend valuable time to modify employee assignments to
respond to absences When employees who are in management or in highly specialised job
assignments report sick the work assigned to them remains undone because their positions
remain vacated and the work remains for them to complete The responsibility and
accountability these employees are entrusted with may influence less use of sick leave by
them
The White Paper on Transforming Public Service Delivery (DPSA 1997) holds management
responsible for the specific level of resources and for obtaining value for money in these
resources
25
Madibana (201022) found in the research about absenteeism amongst nurses that the high
rate of absence had an impact in the reduction of quality care rendered by nurses
291 Cost to the institution
Andrews (19978221) describes an institution as the process through which activities are
grouped logically into the distinct areas and assigned to managers It results in the logical
grouping of activities in a department Workplace absenteeism influences the cost of an
institution which influences the quality of the product or service that is rendered by the
institution Employee attendance is a vital element for managing productivity of any
institution and its individual members The unfilled posts reflect the absence of public
health care employees and do not absorb budget resources for salary and upkeep of
facilities Absent personnel still receive their salaries If public servants are not on the job
the expenditures embodied in them do not reach their beneficiaries (Chaudhury amp Hammer
20032 Lambert et al 20055) The cost is direct in terms of salary expenditure or indirect in
terms of staff replacement
Ferguson et al (200138) argue that the cost of employment risk approach is about
estimation of the possible cost of any absent employee to an institution per hour per day
Robbins Odendaal and Roodt (200415) estimate that absenteeism costs South African
institutions millions of rand a year in decreased efficiency and increased benefit payments
Fakie (20053) notes that sick leave costs the national government 15 of the total basic
salary expenditure for the National Department of Health from 1 January 2001 to December
31 2003
The South African Chamber of Business (SACOB) (Patrick 200117) acknowledges that in
2006 about R19 billion were lost on account of absenteeism resulting from sick leave
According to the European Foundation (19977) United Kingdom lost 11 billion pounds in
1994 Germany lost 30 5 billion EUC in 1993 and Belgium lost 24 billion EUC in 1995
Breetzke (20092) describes indirect costs as hidden costs harder to measure and may
include economic value of lost productivity Indirect costs relate to loss of production that
may arise by engaging some expects to provide service in the field where they are closing
the staff shortage gap Rogers and Hertin (19939) and the European Foundation (19978)
view the individual employee and his or her dependants in a social dimension aspect as
exposed to reduced income as a result of extended workplace absenteeism related to ill
health where long term incapacity is involved
The total cost of employment risk approach is about estimation of the possible cost of any
absent employee to an institution per hour The cost may be direct and indirect such as
overtime low productivity and a decline in morale among workers who are expected to
cover for an absent employee (Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
26
292 Low productivity
According to Jankowitz (19911) high levels of absenteeism are disruptive to production
where operators are interdependent or where levels of service have to be maintained
Buschak Craven and Ledman (199626) argue that absenteeism generates costs for the
institution and productivity problems put an unreasonable burden on the rest of the
employees who are at work An absent employee be it physical or psychological remains an
unproductive employee Absenteeism viewed from an employerrsquos perspective is regarded as
a problem that impacts negatively on service delivery while the employeesrsquo believe their
mere presence in the workplace is being productive
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM
Managing workplace absenteeism remains a challenge for all employers and the Gauteng
Department of Health has not been spared the challenges faced by other institutions as it
provides health care services to the citizens of Gauteng The provision of good quality health
care is vital for the development of human capital The implications of declining quantity
and quality of care is grave when the human capital equity and efficiency which are the
cornerstones of health care service delivery are threatened by employees who are not at
work when expected to be (Gauteng Province 200711) Misuse of sick leave is considered to
be an overriding problem in instances where the employee does not uphold the standard of
honesty and incorruptibility or these values are not considered to be the corporate values of
the institution (Andrews 1997 221-222 MINTRAC 20093)
According to Grogan (2005237) employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
identify trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
Part V Section F(c) (RSA 2001) The workplace can be a virtual office Workplace
absenteeism is perceived to be high in unionised workplace environments where unions are
perceived to be capable of exerting control over the employer and employee relations for
the primary benefit of the employees In the public sector contractual employee benefits
are modified by collective agreements
Public service managers are to focus towards results achievement and be accountable for
the performance of their institutions (Gauteng Province 201023) Workplace absenteeism
can be reduced by tightening up policies and procedures relating to control of absenteeism
and intensifying monitoring processes on absent employees
27
According to Cloete (2004290-297) public institutions are to provide quality goods and
services The public institutions require an appropriate infrastructure to enable them to
perform their core functions (Bamford et al 19991 Buschak et al 1996 28 Munro
200722)
2101 Effective communication
According to Oi-ling (200212) managers should alter the psycho-social environment at work
and cultivate an institutional climate that supports staff and facilitate effective
communication Institutions should raise awareness to employees of their rights and
responsibilities regarding leave of absence and the consequences of abusing it (Bamford et
al 19992) The policies should be clearly written and well communicated to all employees
and be readily available and accessible In a highly unionised environment these policies are
debated in bilateral or multi-lateral forums between management or employer
representatives and labour representatives The human resource practitioners must conduct
periodic in-house training on these policies for management and employees to facilitate
uniform interpretation and enforce compliance by all stakeholders The policies must be
couched in simple understandable language that is free of legal terms for ease of
comprehension by all users The policies on workplace absenteeism must be explicit of
actions to be taken when policies have been violated or employees are aggrieved
2102 Empowerment of managers
Workplace absenteeism is multi-dimensional requiring inputs from all related fields
Managers require on-going support and training on issues that relate to absenteeism at the
workplace The human resource unit works with managers to establish performance
standards training of employees on the importance of execution and assists managers to
focus on continuous improvements superior execution and employee empowerment
(Bergdahl 20019 RSA 2011)
The labour relations unit supports the training of managers on grievance handling bilateral
and multi-lateral encounters with employee representatives with employee education
issues specific to workplace absenteeism The Charted Institute of Personnel and
Development (CIPD) (200835) reported that 70 of managers in the public service have
been trained in workplace absenteeism handling
Employment relationships bind human resource and industrial relations together with the
common objective of achieving institutional goals and labour peace Managers focus on
managing the institution for productivity at the lowest possible cost by providing quality
care therefore reducing the risk of litigation control of absence from work and work
efficiency
28
It is the delays in dealing with issues that give the employees the feeling of being unfairly
treated and demoralised Consistency in upholding these processes is essential for creation
of a stable employment relationship while any deviation from the set processes give rise to
worker unfriendly environment (Bergdahl 20118-9)
2103 Monitoring of workplace absenteeism
The manager is expected to keep accurate records for all leave of absence taken by
employees In terms of the management of ill-health absencersquos the manager has to ensure
that the eight week rule is observed whereby the employee who has been absent from
work on more than two occasions during an eight- week period must regardless of the
duration of the sickness or injury submit a medical certificate (RSA Part V section F (b)
DPSA 2009 section 14 148) Pierce (200921) believes that management of human capital
may be achieved through the integration of employee benefits employee assistance
programmes and human capital
Monitoring of absenteeism is a human resource function that gets lost in the competing
functions that are carried out by human resource practitioners High levels of absenteeism
are an indication of poor management and or conflict within the employment relationship
The methods to monitor workplace absenteeism vary from one institution to the other It is
human resource management that establishes common guidelines that are used by
management to monitor workplace absenteeism In monitoring absenteeism the manager
considers each employeersquos case on its merit
The manager focuses on certain aspects of the case such as failure to call in on the day of
absence pattern of use of sick leave before or after holidays and sick absence occurring on
certain days of the week or month Monitoring systems to monitor and record attendance
of work are put in place to assist management with simple accurate functional data that
facilitates informed decision- taking at management level The employees of the province
and their attendance at work become the focal point of the province in relation to service
delivery Peer pressure monitoring comes from colleagues at the same facility Hierarchical
monitoring of employees by management may lead to more attendance for fear of being
discovered (Chaudhury amp Hammer 200319 Gauteng Province 201015) A health care
service institution may use Health Information System and Personnel and Salary
Administration System (PERSAL) among others to ease the burden of the monitoring
process All these tools combined are useful in gathering administrative data for
management
29
2104 Visits to facilities
The role of human resource at institutional level is to support and guide management as
well as monitor compliance issues Workplace absenteeism remains a key focus area
because of its impact on the budget of an organisation Unscheduled facility visits are
conducted with the view to audit workplace absenteeism The audit is to be done in line
with the auditor-general or internal risk managementrsquos approach to encourage consistency
A check list that is used is prepared by human resource practitioners and institutions are
familiar with A human resource accounting officer of the institution should be involved
when an audit is done
The institution must have evidence available of sporadic visits to employees who have been
identified as having developed absenteeism patterns with the view to rule out elective
absence The European Foundation (199713) and Munro (200722) state that ill- health is
the main reason for workplace absenteeism Employees who present with ill- health are
generally and frequently more absent from work than the healthy ones The authors also
observe that not all employee assistance programmes aimed at reducing workplace
absenteeism have an effect on the ill-health of the employees which render the
unscheduled visit to the employees vital to see where the caring employer could be of
assistance
2105 Incentive system
According to Buschak et al (199628) the catastrophic model (CAT) caters for major illness
that keeps the employee away from work for extended periods of time This model is similar
to short and long term incapacity sick leave which is catered for by PILIR subsection 73
(DPSA 2009) The managers require special training for successful implementation of the
policy The paid time off model (PTO) has hidden benefits incentives for employees not to
use unnecessary sick days which are then paid for at retirement The research by Lambert
and Camp (20054) compares the Civil Service Retirement System (CSRS) and the Federal
Employees Retirement System (FERS) and showed that in the final analysis and when
novelty wore off workplace absenteeism was not necessarily reduced by the incentive
system
Management should use the strategy to raise awareness about responsible utilisation of sick
leave through workshops about PILIR and the eight week rule It should show the benefits
of good sick leave management when employees are challenged with temporary or
permanent incapacity leave
The use it or lose it approach of the current system reward the abuse of sick leave as it is
viewed as not being beneficial by the employees to act responsible towards the use of sick
leave There is no deterrent not to abuse sick leave in the public sector
30
2106 Team support
Institutions value team effort over individual achievement Operational competencies are
viewed as essential Managers encourage effective communication among team members
motivating others and the development of problem-solving skills Managers through the
team development effort encourage nurturing and transmitting of the institutional culture
Institutional culture refers to a system of shared meaning within an organisation that
determines how employees behave in the workplace Culture and people are like glue that
ensures that institutional standards are upheld Individuals become units that form the
team and conversations at work are encouraged to strengthen team work knowledge
transfer and productivity (Bergdahl 20018-10 Goldsmith amp Morgan 200378 Robbins amp
Decenzo 2001174)
2107 Return-to-work interviews
According to Paton (20101ndash5) a phased return-to-work data management and remote
services are among the approaches employers may use to manage workplace absenteeism
The intervention can involve use of Information Technology systems and telephone
discussions Good absence management is about good people management The return-to-
work interviews provide management with the opportunity to get to know the employee
better and for the employee to substantiate his or her case The employee is afforded
privacy during the sessions which should happen as soon as the employee comes back to
work The key success in this strategy is unthreatening follow ups that are done A multi-
faceted approach is used to get people back to work such as phoning maintaining regular
contact and taking medical advice
The Charted Institute of Personnel Development Annual Report (200835) reported 90 of
public services that use the strategy and 77 use the risk assessment to aid return- to-
work The manager should have private counselling sessions with the employee as soon as
the employee returns to work These sessions provide the employee with the opportunity to
put his or her case across and for the employer to get a first-hand opportunity to asses if the
employee is fit enough to come back to work The employer has to make the employee
aware of the status of the meeting that it is formal and proceedings are recorded The
employer is to keep accurate records of all counselling sessions
31
2108 Employee assistance programme (EAP)
DPSA (PILIR2009) prescribes that the PILIR committee promotes EAP in the workplace and
each institution to establish a committee The PILIR committee consists of a labour relations
officer an EAP practitioner a health practitioner an employee wellness practitioner and
any other relevant practitioner who is co-opted on a needs basis The purpose of the
committee is to manage short and long term incapacity which is sick leave utilised after the
employee has exhausted the 36 days normal sick leave in a three year cycle The short term
incapacity sick leave is of longer than three days and less than 29 days and long term
incapacity is sick leave longer than 29 days The short spells of sick leave become a concern
when there is evidence of a pattern of abuse It is a call for the manager to intervene Every
organisation should provide EAP that is funded by the employer to the employees A health
risk manager is used by the employees who are expected to honour referrals and stay with
the programme until such time that there is evidence of recovery failure by the employee
to accept the programme should attract a disciplinary process
According to Mellor Arnold and Gelade (20098) the amount of support that followers
receive from their transformational leader or co-worker may help reduce levels of absence
by making the workplace a more pleasant place to be and perhaps by helping the person
find solutions to work out family conflict or other problems that produce absence Landstad
et al (20011) suggest that the individuals in the preventive intervention group who were
less than 42 years of age total absence due to sickness decreased The change was obvious
to the cleaners who had a previous history of high absence due to sickness The Charted
Institute of Personnel Development (200836) focused on working-man days lost
management of absenteeism employee well-being and employee rehabilitation The skilled
employees were reported as 12 who were using rehabilitation programmes Yende
(200535) and Fakie (200517) state that EAP despite having been around since 1996 for the
National Department of Health has not actually been managed and utilised to its full extent
whereby if fully utilised would assist in the management of employee workplace
absenteeism
2109 Occupational and safety committee
The focus of this committee is on the provision of a safe working environment by the
employer (RSA Part VI section D 2001) It monitors issues of compliance and adopts the
employee advocacy role The committee consists of all the major stakeholders such as
employee representatives labour representatives that represent employees in the
institution on issues of safety at the workplace In the context of the Gauteng Department
of Health the committee engages with the labour representatives and employer
representatives at bilateral and provincial multi-lateral scheduled meetings
32
According to Du Toit and Van Der Waldt (1998139) the International Labour Organisation
recommends creation and maintaining of a pleasant work environment in order to improve
productivity The environment must stimulate the employee to ensure efficiency and
effectiveness
21010 Review committee
This structure is essential when dealing with incapacity leave It is composed of
management human resource practitioner employee representative labour relations
officer employee wellness and any adhoc person needed in terms of the case under
discussion (DPSA PILIR 2009) The employee reserves the right to lodge a grievance about
the outcome of his incapacity request if it is negative The role of the committee is to
provide a transparent forum reduce hostility against management and to protect the rights
of the employee through involvement of the employee representative
211 CONCLUSION
The literature review that has been consulted explores the workplace absenteeism and its
impact on the institution The employment relationships represent a triangle that consists of
the employer the employee and the industrial environment The relationship is multi-
dimensional and highly regulated with built in mechanisms to handle conflict in the
workplace Conflict is inherent to the employment relationship and structures and
mechanisms such as bargaining councils the Commission for Conciliation Mediation and
Arbitration and Labour Courts are structures for recourse The theory of absenteeism and
employment relationship were explored Management intervention strategies were
explained Controlling absenteeism in the workplace begins with a sound absenteeism
policy that is incorporated into an employee induction programme Communicating and
educating the employees about the absenteeism policy takes the centre stage in the
employment relationship Vigilant monitoring of workplace absenteeism is the responsibility
of the manager closest to the employee such as the supervisor Workplace attendance
problems of employees can be handled using sound judgement keeping accurate
attendance records and administering the policy fairly and consistently
Chapter 3 will collect data which will confirm or negate the literature review that has been
explored in chapter 2
33
CHAPTER 3
METHODOLOGY OF THE RESEARCH
31 INTRODUCTION
Chapter 3 focuses on the methodology used to determine the absenteeism in the four
hospitals of the Gauteng Department of Health The research design and the methodology
that have been used to collect data are discussed below The data are collected in terms of
the characteristics of the stratified random sample such as absenteeism of the different
occupational categories gender age tenure of service race groups and salary
32 RESEARCH DESIGN
A research design is the overall plan for relating the conceptual problem to relevant
empirical research It is a quantitative descriptive research that involves the systematic
collection of numerical information under conditions of considerable control The choice of
the research design influences subsequent research activities such as identifying the target
subjects what data to collect and how they should be collected The research design is a
descriptive survey which is concerned with characteristics of a specific population subject at
a fixed point in time for comparative purposes The focus is on a representative sample of
the relevant population It is concerned with the accuracy of the findings and their
generalisability The survey is used to understand the behaviour of employees with regards
to motivation satisfaction and grievances (Babbie 1992 89 Ghauri et al 199527 60 Brink
199611 Welman et al 200152)
321 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services The four hospitals that have been targeted for the study of absenteeism are Tara
Moross Centre Hospital in Region A under the Johannesburg Metropolitan Municipality
Germiston Regional Hospital which is in Region B under Ekurhuleni Metropolitan
Municipality ODI District Hospital in Region C under Tshwane Metropolitan Municipality
and George Mukhari Academic Hospital in Region C under Tshwane Metropolitan
Municipality Each hospital is unique in its character in terms of specialisation of health care
delivery service The sample is a stratified random sampling which is composed of various
clearly recognisable non-overlapping sub-populations (strata) that differ from one another
in terms of variables that are a combination of more than one variable such as age sex
income level or educational level The purpose is to ensure that every part of the population
(every stratum) is represented The members of a particular stratum are homogeneous with
the population at large
34
The sample is representative of a population with clearly distinguishable strata with a
greater degree of certainty (Babbie 19927 Brink 1996138 Brynard amp Hanekom 2005 44
Ghauri et al 199578 Welman amp Kruger 200155-56 Polit amp Hungler 199518)
The data were collected in three phases The first phase of data collection was done through
auditing of hard copies of identified personnel files encomprising ten files per hospital and
using the tools in annexure A and B The forty employeesrsquo profiles were accessed through
the Human Resource Information System (HRIM) located in the Gauteng Department of
Health Head Office The respective employeesrsquo profiles were handed over to the human
resource manager in the respective hospital on the morning of the audit for the human
resource practitioner to draw out the hard copy files for auditing The characteristics of the
individuals that were identified for the first phase were males and females as well as
representatives from the different race groups The auditing of the files were for the
complete working life of the employees and not only confined to 2008 calendar year
Registers that are used by human resource administration to control the movement of the
leave form were inspected as evidence of the control system in place The purpose of
auditing the files was to gain insight into how leave in general was captured managed and
controlled by the hospitals
The second phase of data collection were done through structured interviews with four
human resource managers who were directly accountable for management and control of
leave of absence in general in the four hospitals A structured interview provides for a more
organised approach and a more stable basis for assessment of the different candidates
(Erasmus et al 2005250) The structured interview was conducted using the tool in
annexure C Tara Moross Centre Hospital had been functioning without a human resource
manager and the manager that was interviewed had been in the post for three months The
human resource practitioner who was at salary level 8 and acting in the Assistant Directorrsquos
post (manager level 9) was invited to join the manager and be part of the structured
interview ODI District Hospital had three human resource practitioners including the
accounting officer at level 8 in an acting capacity The third phase of data collection was
through the Human Resource Information Management System (HRIM) This system uses
the Personnel Remuneration Administration System (PERSAL) to collect data Data in this
system is categorised in characteristics such as salary level date of appointment
occupational category gender age in units of five race employing hospital employment
status in different sub-categories such as session contract and full-time and the different
types of leave of absence The continuous sick leave of four to five days was excluded from
processing and focus was laid on sporadic days to the start and end of a weekend
35
The research used secondary data in analysing sick leave utilised by full time employees in
the identified hospitals for the period of 1 January to 31 December of 2008 using Persal The
total population sample was four thousand and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range from level 1 to
12 The research used past events such as sick leave utilised by employees using secondary
data from Persal falling into the category of historical empirical study The interval scale of
measurement was used in the quantitative research and actual numbers are ordered with
equal measurement between each category (Brink 1996 149 Brynard amp Hanekom 200528-
29 Mouton 200552100170)
33 UNIT OF ANALYSIS
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the study refers to observation of work attendance by the
employees of Gauteng Department of Health in the four hospitals The observation deals
with the historical events as employees have already utilised the sick leave in the workplace
The subjects that are studied are the core health care providers such as doctors nurses and
support employees such as allied administration and administration support (Mouton 2005
51-52 Welman et al 2001 52-53)
34 UNIT OF OBSERVATIONS
The observations that are made are of health care employees and support teams in Tara
Moross Centre Hospital Germiston Hospital ODI Hospital and George Mukhari Hospital
and describe the characteristics of a large number of individual people such as sex age
salary range occupational category tenure of service and race in relation to absenteeism in
the workplace The descriptive study and the individual characteristics are aggregated for
the purpose of describing a larger group (Babbie 199292)
35 CONSTRUCT VALIDITY
Construct validity is concerned with the question What construct is the instrument actually
measuring (Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with four of the accounting officers in the leave managements The third phase was
collecting of personnel data through the Persal system
36
36 ETHICAL CONSIDERATIONS
Ethical considerations will include amongst other issues such as the protection of the units
of analysis and units of observations from discomfort and harm by not revealing
information which can cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity
Anonymity is achieved when the researcher cannot link a given response with a given
respondent and reporting aggregate data only When data are collected at one sitting and
not over a period of time makes it possible to achieve anonymity as the need for follow up is
eliminated Subjects of observations are selected for reasons directly related to the problem
being studied as the principle of justice Confidentiality is about the researcherrsquos
responsibility to protect all data gathered within the scope of the study and shared only
with people involved in the research (Babbie 1992465ndash466 Brink 199640ndash41 45 Polit amp
Hungler 1995 31-36)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous to the researcher The interview was part
of the actual audit that was done as part of monitoring and evaluation that was in progress
in the Department of Health following a negative auditor generalrsquos report about
management of leave in general The managers were put at ease as they were given the
checklist afterwards for self-monitoring and for future self-auditing
The data that were collected through Persal identified employees through the Persal
number and kept their identities anonymous The data that were collected through the hard
copy of employeesrsquo files were used to point out areas of concern to the managers and the
files did not leave the office of the manager at the end of the process once more protecting
the identity of the employee
37 CONCLUSION
This chapter dealt with the research design which is the overall plan for relating the
conceptual problem to relevant empirical research The methodology used a stratified
random sample which is composed of various clearly recognisable non-overlapping sub-
populations that differ from one another in terms of variables that are a combination of
more than one variable The data collection was done through three phases The unit of
analysis refers to the persons who are studied The unit of observations are health care
workers and support teams in the four identified hospitals The construct validity used a
multi-trait multi-method approach Ethical considerations include among other issues
protection of the unit of analysis and the unit of observations from discomfort and harm
Chapter 4 discusses the analysis and interpretation of the data gathered in chapter 3
37
CHAPTER 4
INTERPRETATION AND ANALYSIS OF DATA
41 INTRODUCTION
This chapter focuses on the research analysis and interpretation of data gathered on
workplace absenteeism in the Department of Health of the Gauteng Province It seeks to
identify differences or similarities in the leave trends in the 2008 calendar year between the
four identified hospitals chosen for the study in the Municipality of Tshwane Ekurhuleni and
Johannesburg The year 2008 was chosen as a second year in the leave cycle that started in
2007 The type of leave of absence is interpreted as a collective that does not specify the
type of sickness or illness or it being acute or chronic Workplace absenteeism is absence of
the employee at the workplace that is defined by Du Toit and Van Der Waldt (1998139) as
the place that the institution makes available and where officials have to perform their
work It forms part of the internal environment for public administration in the public
service Direct public administration is directly concerned with the rendering of services to
the citizens of the country
Chapter 4 discusses the study of workplace absenteeism in the four identified institutions
namely Tara Moross Centre Hospital Germiston Hospital ODI District Hospital and George
Mukhari Hospital In this research the following factors will be examined the organisational
structure and absenteeism of the different workforce categories such as medical and
nursing professionals administrative staff allied professionals and various categories of the
general assistants workforce and their relation to absenteeism in the institution
42 THE STRUCTURE OF THE ORGANISATION
The Gauteng Province is one of the nine provinces of South Africa In 2005 the auditor-
general conducted an audit of sick leave performance in six national departments and the
Gauteng Province was among those that were omitted from the audit The research focuses
on the Gauteng Department of Health (GDoH) whose core function is to provide health care
services to the people of Gauteng The provision of health care services is labour intensive
and requires large numbers of personnel for effective service delivery The GDoH is serviced
by thirty-four hospitals four of which have been identified for the study of management of
sick leave The employee attendance to work is essential to the achievements of the
Departmental goals The Determination on Leave of Absence determines the leave policy for
public service employees (DPSA 2009) The employees of GDoH represent the staff
component as reflected in the organisational structure of the department
38
The Gauteng Department of Health (GDoH) provides the basic health services to the people
of Gauteng who as internal or out-patients are clients or consumers of the services referred
to as line functions Public administration services rely heavily on support services such as
the personnel department that renders support to line functions that provide the actual
service of patient care Support services are considered as indirect public administration
services and essential in efficient public service delivery Workplace absenteeism has a
negative impact on productivity Employees of the Gauteng Department of Health and their
attendance to work are the focal point of the Province in terms of effective health care
service delivery that is customer focused
Political ideologies as those espoused by labour representatives are part of the external
factors in the workplace environment that consequently have an impact on public
administration and management and workplace attendance by employees (Du Toit amp Van
Der Waldt 1998139170)
FIGURE 41 INTERGRATED ORGANISATIONAL STRUCTURE
(Adapted from Gauteng Department of Health organisational structure 2010)
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY
The Gauteng Provincial Government has made a commitment to its people to account for
the delivery of services as its electoral mandate This commitment will be achieved only
when monitoring and evaluation of its performance is enforced by all Gauteng Department
of Health service providers
39
MEC
HOD
COP
Senior Exec
CD HAST CD Health program
Senior Exc
CD Tshwane
CD JHBWest
CFO
Manage Account
SENIOR CORPORATE
HRM amp LR
GenderampDisability
The Gauteng Governmentrsquos commitment to provision of health care services to all its
citizens is demonstrated by the decentralisation of management of service delivery with the
view to foster accountability increase efficiency and accountability (ANC 199419ndash20
Goldstein 200815) The interpretation of the analysed data takes the sector performance
approach into consideration when the interpretation of absence is across all the
occupational groups for the 2008 calendar year (Gauteng Province 201015)
44 COMPARISON OF HOSPITALSPERMANENT EMPLOYEES
Gauteng employees are counted at 51475 from the Personnel Salary Administration System
(PERSAL) as of March 2008 The population from the four chosen hospitals has been
counted at 4010 reflecting 8 of the total population The different groups of employees
were identified as Africans represented as n=3902 Whites as n=51 Indians as n=14 and
Coloureds as n=43
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALS
(Source Compiled by the researcher C S Ndhlovu 2012)
Figure 42 reflects the racial split percentage of the workforce (n=4010) of the hospitals
The population from the four hospitals has been counted as 4010 reflecting 8 (n=51475)
of the total working population for Gauteng Department of Health as from 1 January to 31
December 2008 The different groups of employees were identified as Africans represented
by 973 (n=3902) Whites as 13 (n=51) Indians as 03 (n=14) and Coloureds as 11
(n=43) The George Mukhari Hospital has a female dominated workforce at 739 (n= 2097)
in a total workforce of n=2836
40
Population n=4010
Africans 973
Whites 13
Coloureds 11
Indians 03
TABLE 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALS
RACE TARA HOSPITAL GERMISTON GEORGE
MUKHARI
ODI TOTAL
Africans 227 367 2836 472 3902
Whites 23 24 3 1 51
Coloureds 5 37 0 1 43
Indians 13 1 0 0 14
Population 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 1 focuses on the distribution of race and the population of the total workforce The
geographical area of the hospital determines the demographics and the tendency of some
groups being poorly represented or totally absent The research focused on permanent
employees of the four hospitals The George Mukhari Hospital employees are reflected as
7079 (n=2839) ODI Hospital as 1182 (n=474) Germiston Hospital as 1069 (n=429)
and Tara Moross Centre Hospital as 668 (n=268) of the total working population Tara
Moross Centre and Germiston Hospitals are located in cosmopolitan areas while the George
Mukhari and the ODI Hospitals are in rural and semirural areas The positioning of the latter
hospitals may account for the high African workforce
41
TABLE 2 COMPARISONS OF NUMBERS OF ADMINISTRATION AND SUPPORT STAFF IN THE
DIFFERENT HOSPITALS
OCCUPATIONAL
GROUP
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Administration
staff
48 60 297 61 466
Administration
support
103 140 719 133 1095
TOTAL 151 200 1016 194 1561
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 2 presents the administration employees and the administration support in the four
hospitals Tara Moross Centre Hospital is represented by 3179 (n=151) of administration
and 6822 (n=103) administration support The George Mukhari Hospital has the highest
representation by the administration support at 7077 (n=1016) The high representation
of the administration support staff at George Mukhari Hospital could be partly because of
the semi-rural environment A semi-rural environment is usually characterised by poverty
which may have a negative influence on opportunities to access education and skills
Doctors and nurses are highly marketable because of the educational levels and skills that
are lucrative and enable this group to be highly mobile geographically (Chaudhury amp
Hammer 20033)
42
TABLE 3 GENDER COMPARISON IN DIFFERENT HOSPITALS
GROUPS HOSPITALS MALE FEMALE POPULATION
Africans Tara 83 144 227
Germiston 52 315 367
George Mukhari 739 2097 2836
ODI 109 363 472
TOTAL 983 2919 3902
Whites Tara 5 18 23
Germiston 5 19 24
George Mukhari 3 0 3
ODI 1 0 1
TOTAL 14 37 51
Indians Tara 1 12 13
Germiston 0 1 1
George Mukhari 0 0 0
ODI 0 0 0
TOTAL 1 13 14
Coloureds Tara 1 4 5
Germiston 6 31 37
George Mukhari 0 0 0
ODI 1 0 1
TOTAL
GRAND TOTAL
8
1006
35
3004
43
4010
(Source Compiled by C S Ndhlovu 2012)
Table 3 focuses on gender distribution in the population of the research represented by
males and females in the different racial groups
43
The geographical area of the hospital determines the demographics and the tendency of
some groups being poorly represented or totally absent The males of the different hospitals
account for 251 (n=1006) while the females account for 749 (n=3004)
The George Mukhari Hospital has a female dominated workforce at 7394 (n=2097) out of
a total workforce of n=2836 White male employees are represented by 011 (n=3) against
the total workforce of the hospital (n=2839) There are no Indians and nor any Coloured
employees African males are represented by 2603 (n=739) The same hospital has no
white female employees no Indians no Coloureds and 7395 (n=2097) African females
The table reflects a predominantly African female workforce The hospital is situated in a
rural setting and this may have an impact on the vast difference in the gender
representation
The Tara Moross Centre and Germiston Hospitals are located in cosmopolitan areas They
have 187 (n=5) and 1117 (n=5) White male employees respectively and 672 (n=18)
and 443 (n=19) female employees respectively Tara Moross Centre Hospital has 4 48
(n=12) female Indian employees while Germiston Hospital has only 024 (n=1) Germiston
Hospital has 723 (n=31) female Coloured employees while Tara Moross Centre has 150
(n=4) The core function of the various hospitals may have influenced the gender
distribution
TABLE 4 COMPARISON OF TENURE OF SERVICE IN RELATION TO ABSENTEEISM IN THE
FOUR HOSPITALS
TENURE IN YEARS DAYS OF ABSENCE PERCENTAGE
1ndash10 4451 30
11ndash20 6577 443
21ndash30 2934 198
31ndash40 878 59
TOTAL 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 4 reflects the level of tenure of the total workforce from 1 year to 40 years of service
Tenure of 11 years to 20 years of service reflects 443 (n=6577) utilisation of leave of
absence and remains the highest rate of absenteeism followed by tenure of 1 to 10 years of
service at a 30 absenteeism rate
44
TABLE 5 COMPARISON OF THE OCCUPATIONAL GROUPS IN THE DIFFERENT HOSPITALS
OCCUPATIONAL
CATEGORIES
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Doctors 12 12 354 19 397
Professional
nurse
47 81 548 109 785
Staff nurse 15 53 358 56 482
Nurse assistant 16 50 308 55 429
Social worker 4 4 8 3 19
Occupational
therapists
4 0 15 1 20
Radiographer 0 3 27 6 36
Clinical
Psychologists
4 0 10 2 16
Physiotherapists 0 1 9 1 11
Dieticians 0 0 5 3 8
Finance 4 11 59 9 83
Speech
therapists
0 0 5 1 6
Pharmacists 2 9 36 5 52
Dentists 0 0 0 3 3
Technicians 2 5 51 6 64
Librarian 1 0 0 0 1
Security 6 0 30 1 37
Administration
and support
151 200 1016 194 1561
TOTAL 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 5 reflects a great difference in terms of number of occupational groups in the four
hospitals
45
The core function and the size of the hospital seems to have a bearing on how many
occupational categories of employees are to be found in that hospital as well as the actual
figures of these categories The George Mukhari Hospital is an academic hospital that trains
medical doctors This hospital has 1247 (n=354) doctors in a staff establishment of
n=2839 Tara Moross Centre has 448 (n=12) in a staff establishment of n=268 Germiston
has 280 (n=12) in a staff establishment of n=429 and ODI District hospital has 401
(n=19) in a staff establishment of n=474 This trend of vast differences in figures
represented by the occupational groups is evident in the category of professional nurses
where George Mukhari Hospital reflects 1931 (n= 548) nurses Tara Moross Centre is
represented by 1754 (n=47) Germiston by 1889 (n=81) and ODI District hospital by
23 (n=109) The impact of absenteeism is pronounced when viewed against the level of
facility capacity in terms of human resources of the core occupational groups
441 The Tara Moross Centre Hospital
Tara Moross Centre Hospital is a speciality psychiatric hospital in Region A with a workforce
of 669 (n=268) of the total workforce (n=4010) The core function of the hospital is
specialised such that some occupational categories are not available in the hospital as part
of the workforce and patients are referred out to other facilities for specialised treatment
Tara Moross Centre Hospital falls under the jurisdiction of the Johannesburg Metropolitan
Municipality
442 The Germiston Hospital
Germiston Hospital is a regional general hospital in Region B with a total permanent staff
establishment of 1070 (n= 429) of the total workforce (n=4010) The hospital falls under
the Ekurhuleni Metropolitan Municipality It does not have occupational therapists clinical
psychologists dieticians speech therapists and dentists in its permanent staff
443 The ODI District Hospital
The ODI District Hospital is in Region C and is in transition due to boundary changes It is
being transferred from the North West Province to the Gauteng Province The hospital is in
a semi-rural area with a staff component of 118 (n=474) of full-time employees (n=4010)
and falls under Tshwane Metropolitan Municipality It is a general district hospital
444 The George Mukhari Hospital
The George Mukhari Hospital is an academic hospital in Region C under Tshwane
Metropolitan Municipality The hospital trains doctors and employs 010 (n=3) White male
employees 26 (n=739) African males and7184 (n=2097) African females out of the
total female workforce (n=2919)
46
This phenomenon may be as a result of the hospital having the highest general assistants
workforce at 2065 (n=586) out of the workforce (n=2839) The George Mukhari Hospital
has the highest number of general assistants out of the four hospitals represented as 25
(n=719) in a total workforce of n=2836 African employees
45 RESEARCH INTERPRETATION
The interpretation of leave of absence is confined to salary level 1 to 12 full time employees
of the Gauteng Department of Health who took leave of absence from the workplace for the
calendar year in 2008 It excludes the contract employees periodic remuneration foreign
employees and permanent employees above salary range 13
The Basic Conditions of Employment Act 75 of 1997 Section 9 (3) (RSA 1997) prescribes
procedures in terms of progressive reduction of the maximum working hours to the goal of
a 40-hour working week and an eight-hour working day Finnemore and Van Rensburg
(2002462) state that the reduction of maximum working hours to 40 hours a week is done
through collective bargaining with due regard to job creation efficiency and health safety
and welfare of employees Du Toit and Van Der Waldt (1998232) use the formula to
aggregate lost working-man hours due to ill health and disability as aggregate lost hours in
the survey period divided by 40 hours in a week and x number of hours in a year A formula
to work out the absenteeism rate by Pierce (2009) is represented as A=BC A= Absenteeism
rate B= Total number of days lost due to absenteeism in a given period C= Total number of
working- man days available in the given period C=D x E D=Total number of employees
planned to work in the given period E=Number of available working days in the given
period
The approach of the research uses the principle of absence from the workplace when due to
work to identify the lost working hours (Pierce 2009 Davey amp Cummings 2009313) The
study applies a retrospective approach
The working-man lost days for the Province in the four hospitals is approached in terms of
lost working -man days simplified refers to the number of days meant to have been worked
but actually not worked due to illness or disability by the employees in a year divided by the
total number of employees of the public sector (PXVI) Barker (200779) argues that a
reduction in working hours increases the hourly cost of production and unit production
unless there is a commensurate increase in productivity This approach has a similar effect
on workplace absenteeism when the workload of those employees who are present
increases as they carry the double load to meet the demands of service delivery The cost of
absence to the Province is expressed as salary expenditure for each day of leave of absence
from the workplace (PSC 2002 xiii Pierce 2009)
47
The salary range is laid down according to Annexure in DPSA Circular 1 of 2008 The Gauteng
Government experienced a cost estimated at R29 million in 2000 and approximately R54
million in 2001 from absenteeism and loss of working time (Parbhoo20031)
The formula that is used in this research to calculate lost man work-hours is collective
working days of absence multiplied by 8 hours in a working day resulting in the total
working hours that are lost This formula can be represented as
Lost days x hours (8) in a working day = lost working hours
As stipulated by the Basic Conditions of Employment Act 75 of 1997 section 9 1(c) 3
TABLE 6 RACES IN RELATION TO ABSENTEEISM
RACE TOTAL DAYS OF ABSENTEEISM PERCENTAGE
Africans 14295 963
Whites 242 16
Coloureds 201 14
Indians 102 07
TOTALS 14840 100
(Source Compiled by the researcher 2012)
Table 6 represents absenteeism in the diverse races in the workplace The absenteeism rate
seems to be proportional to the number of employees The Employment Equity Act 55 of
1998 defines the term ldquoblackrdquo as a generic term which means Africans Coloureds and
Indians The Africans as a race group is represented by 963 (n=14295) of the total
working days lost (n=14840) The high figure of lost working-man days reflects the
demographics of the four hospitals The George Mukhari Hospital is in a rural setting that is
predominantly African populated and employs the highest number of Africans as
represented in table 3 Whites are presented by 16 and not represented in all
occupational categories and salary ranges that could explain the low figures and
percentages associated with working-man days lost Africans constitute the highest number
of employees as well as the highest percentage of working-man days lost Absenteeism
percentage is proportional to the employment figures for this race group The Indian race
group is represented by the lowest figure of employment and lowest percentage of leave of
absence which is proportional to the employment figure
48
TABLE 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM
OCCUPATIONAL
GROUPS
TARA GERMISTON ODI GEORGE
MUKHARI
TOTALS
DOCTORS 22 118 5 290 435
PROFESSIONAL NURSE 272 346 20 2459 3097
STAFF NURSE 128 247 13 1568 1956
NURSE-ASSISTANT 150 126 25 1145 1446
FINANCE 0 0 0 386 386
ADMINISTRATION 57 272 20 1923 2272
ADMIN SUPPORT 754 547 163 3784 5248
TOTAL 1383 1656 246 11555 14840
(Source Compiled by C S Ndhlovu 2012)
Table 7 reflects the working-man days lost by the different occupational groups The
doctorsrsquo workload in terms of the annual report for Gauteng Department of Health
(2008951) was 226 as against the target of 227 while the national target was 187
The bed occupancy rate target for the same time was 75 while the actual figure was
653 The annual report interpreted in conjunction with the data of leave of absence for
doctors reflects a negative impact in terms of service delivery and the cost factor to the
department
451 Occupational groups in relation to absenteeism
The multi-group invariance structural model presents different types of occupations and is
used to identify variance in the patterns in terms of occupational groups The model allows
different relationships between variables in different occupations The different
occupational groups are doctors professional nurses and sub-categories administration
staff and administration support staff (Pousette amp Hanse 2002230) According to Gaudine
and Gregory (2010599) absenteeism was a problem among health care workers in
comparison to other employees in other sectors The cornerstone of an efficient health care
service delivery is equity and efficiency which is threatened when employees are not at
work when expected to be (Andrews 199734-35 DPSA 1997)
49
According to the Charted Institute of Personnel Development (200811) the survey that was
conducted found that public sector employees are less likely to be disciplined or dismissed
for reasons of workplace absenteeism
Tables 5 and 6 and 7 reflect the different occupational groups and the level of absenteeism
in the four hospitals of the Gauteng Department of Health
4511 Doctors
Doctors are represented by 10 (n=397) of the total working population (n=4010) The
29 (n=435) indicates the number of working-man days lost in relation to the total
working- man days lost (n=14840) The percentage of working- man days lost in relation to
the total number of full time employees of the four hospitals is reflected as 435 divided by
n=4010 times the percentage which results in 108 (n=435) working-man days lost
multiplied by 8 hours that represent a working day The outcome is n=3480 working-man
hours The cost to the Province is calculated in terms of the salary expenditure as direct and
indirect salary payment for lost working-man hours estimated at 3480 hours at salary level
10 at R217 482 to salary level 12 at R 407745 as well as indirect costs such as replacement
of staff and overtime
The doctorsrsquo workload in terms of Gauteng Province 20089 annual report (2008951)
reflects the doctorrsquos workload as 226 as against the target of 227 while the national
target is reflected as 187 The bed occupancy rate target for the same time is 75 while
the actual target rate is 653 The annual report when interpreted in conjunction with the
data of leave of absence for doctors reflects a negative impact in terms of service delivery
and the cost factor to the Department when considering a loss of n=3480 man hours of
work
Chaudhury and Hammer (200311) found in their research that the doctors presented the
highest absenteeism rate Serneels et al (2008210) argue that absenteeism is rife in the
public sector where employees hold two jobs and is highest among doctors The doctor
absenteeism rate in the research does not stand out as high in comparison with the other
occupational groups The doctor absenteeism rate is 29 when compared to the total
workforce This occupational group is represented by 10 of the total population The
doctorsrsquo absenteeism rate does not seem to be outstandingly high in comparison with the
other occupational groups in relation to the total number of permanent doctors
50
4512 Professional nurses
The professional nursesrsquo absenteeism is reflected as 208 (n=3088) that indicates the
number of working-man days lost in relation to the total working-man days lost (n=14840)
The percentage of working-man days lost in relation to the total number of full time
employees (n=4010) in the four hospitals is reflected as 77 The cost to the Province
translates into direct and indirect salary expenditure which is spread from salary level 4 to
12 at R64 410 to R407 745 in 2008 for the total duration of lost working days
Du Toit and Van Der Waldt (1998232) pointed out a crisis in four other public hospitals in
the Gauteng Province that was caused by budget cuts and shortage of doctors and nurses in
2008 The vacancy rate of 697 in the professional nurse category and the absence rate of
208 in 2008 in the four hospitals seem to point to a lack of adequate human resources for
effective health care delivery The extent of working-man hours lost in the findings of the
research suggest a high rate of absenteeism and not a good reflection of happiness as
suggested in the annual report Professional nurses are second to the administration
support in absenteeism at 208 at a total of (n=785) nurses in the four hospitals with
absenteeism of n=3088 working-man days lost or n=20704 working-man hours lost This
category of employees is classified as skilled to highly skilled at salary range of 4 to 12The
total vacancy rate was at 697 as against the national target at 15 in 2008 with
absenteeism of 208 Madibana (201022) found in the research about absenteeism
among nurses that the high rate of absence had a negative impact in the quality of health
care rendered by nurses
4513 Staff nurses
Staff nurses are reflected in tables 4 and 5 as representing 12 (n=482) of the total working
population (n=4010) The 132 (n=1956) indicates the number of working-man days lost
in relation to the total working-man days lost (n=14840) times the percentage
The percentage of working-man days lost in relation to the total number of full time
employees in the four hospitals is reflected as 488 The cost to the Department is
expressed as direct and indirect salary expenditure for n=15648 working-man hours lost
The impact of leave of absence to health care services and cost to the Department is the
same as the professional nurses as staff nurses are a sub-category of the nursing profession
4514 Nursing assistants
Nursing assistants are reflected in tables 4 and 5 as represented by 107 (n=429) of the
total working population (n=4010) and 97 (n=1446) represent working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The
percentage of working-man days lost is reflected as 36 (n=1446) in relation to the total
number of employees in the four hospitals (n=4010)
51
The cost of leave of absence to the Department is expressed as the salary expenditure at
salary levels 3 to 6 Salary level 3 is at R54 876 salary level 4 is at R64 410 salary level 5 at
R76 194 and salary level 6 is at R94 000 for n=11568 working-man hours lost and staff
replacement and overtime
4515 Finance officers
Finance officers are reflected in tables 5 and 7 as represented by 21 (n=83) of the total
working population (n=4010) and 26 (n=386) indicates the working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The cost to the
Department is reflected as salary expenditure from salary level 2 at R47 787 to salary level
10 at R217 482 for R2 728 working hours lost The institutions reflected a small number of
this occupational category as permanent employees place them in the category of scarce
skills
4516 Administration staff
The administration staff is represented in tables 2 and 4 and 5 by 116 (n=466) in the total
working population (n=4010) and 153 (n=2272) indicates the working-man hours lost in
relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 567 represent the working-man days lost in relation to the total number of
full time employees in the four hospitals (n=4010) The cost of leave of absence to the
department is reflected as salary expenditure at salary level 4 to 12 Salary 4 at R64 410 to
salary level 12 at R407 745 for 18176 working hours lost
4517 Administration support
The administration support is reflected in tables 2 and 4 and 5 as represented by 273
(n=1095) of the total working population 354 (n=5248) indicates the working-man days
lost in relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 1309 (n=5248) indicates the working-man days lost in relation to the total
number of employees in the four hospitals (n=4010) The total cost to the Department is
reflected as salary expenditure at salary level 2 to 3 at a cost of R47 787 to R54 879 for
41984 working -man hours lost
The highest percentage of absenteeism in the different categories of employees in the four
hospitals is identified in the administration support category It is this category that falls into
the salary range of 2 and 3 which is classified in the Gauteng Province 20089 annual report
(20089325) as lower skilled employees This category represents the highest single
category of employees for the Department at n=1095
52
The impact to the core service delivery employees that require support from administration
staff would seem to be negative as the absence of employees from the workplace would
hamper the smooth workflow Barker (2007214-224) acknowledges the decline in the flow-
through rate in the school education higher grades namely Grade 11 and Grade 12 and
ventures to give possible reasons for this phenomenon The Gauteng Department of Health
as a possible employer has attracted a high percentage of the labourer category as
identified in table 3 totalling n=1095 which is 273 of the total workforce Pousette and
Hanse (2002230-231) suggest that the employeersquos authority to make decisions in his or her
job and the breadth of use of skills used by the employees at work become different aspects
of control with human service at work This approach suggests that reduced job autonomy is
associated with higher sickness absence The administrative support employees are involved
in mechanical or manual labour that predisposes them to musculo-skeletal problems The
work environment could have a negative impact to the high absenteeism rate in this group
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM AS REPRESENTED BY
THE HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 43 reflects the absenteeism rate of the different occupational groups as represented
by the hospitals The George Mukhari Hospital contributes 7079 to the total workforce
and contributes about 779 to absenteeism The absenteeism rate does seem to be low at
7 when considered in the light of the contribution The question that maybe be raised is
whether the relative low absenteeism is indicative of high morale of a happy workforce
53
ODI 17
TARA 93
GERMISTON 111
GEORGE MUKHARI 779
Germiston Hospital contributes 106 to the total workforce and the absenteeism is
reflected as 111 which seems to be above its contribution to the workforce by 1 The
professional nurse and the administration category present with the highest rate of
absenteeism in this hospital The Tara Moross Centre Hospital contributes 67 of the total
workforce and the absenteeism rate is at 93 which is 26 higher The administration
support and professional nurses present with the highest level of absenteeism in this
hospital The ODI Hospital contributes 6 to the total workforce and the absenteeism rate
which seems to be low is reflected as 17 This hospital has no access to the Persal system
and is dependent to a neighbouring hospital It is highly probable that the information is not
accurate
Allen (1984 331) found that union members might be absent more frequently from the
workplace than non-members because they face smaller penalties for absenteeism The
Charted Institute of Personnel and Development (CIPD) (200811) claim that the 2006
survey of absence management portrays the public sector employees as less likely to be
dismissed for reasons of workplace absenteeism
TABLE 8 SALARY RANGE IN RELATION TO ABSENTEEISM (SALARY RANGE 1-12)
SALARY RANGE DAYS OF ABSENCE PERCENTAGE
1-2 178 12
3-4 5235 353
5-6 2044 138
7-8 5139 346
9-10 1878 126
11-12 366 25
TOTAL 14840 100
(Source Compile by the researcher C S Ndhlovu 2012)
Table 8 reflects the salary range with the lowest working days lost as salary level 1 to 2 This
is proportional to the number of employees The highest absenteeism rate has been noted
in the salary range at level 3 to 4 while salary ranges at level 11 to 12 reflected a low rate of
absenteeism The latter salary range is at middle management level and the responsibility
the employees carry may be responsible for the low absenteeism rate Rogers and Hertin
(1993219) noted that the level of education seem to have influenced the use of sick leave
where the lower level category employees were found to have higher level of absenteeism
than higher educated employees
54
TABLE 9 AGE IN RELATION TO ABSENTEEISM
AGE IN YEARS DAYS OF ABSENCE PERCENTAGE
20 to 24 16 010
25 to 29 405 272
30 to 34 733 493
35 to 39 1582 1066
40 to 44 2676 1803
45 to 49 3318 2235
50 to 54 3046 2052
55 to 59 2235 1506
60 to 64 829 558
TOTAL 14840 9999(100)
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 9 reflects age in relation to absenteeism in the four hospitals The age group at 20 to
24 years reflects the lowest figure in working-man days lost at 010 (n=16 days)
Reday-Mulvey (200579) observed that employees over 45 years take marginally fewer short
sick leave days per year than those under 45years
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 to 55 years
as middle -age and shows this group as presenting with a high incapacity leave usage In the
research the age group 45 to 49 years presented with 2235 (n=3318) working-man days
lost and is the highest figure of absenteeism in all age groups The age group at 20 to 24
years is reflected as the lowest absenteeism rate in working-man days at 010 and this
could be related to the number of employees in this age group
According to Reday-Mulvey (20057988) and the Canadian Nurses Association (20065)
employees that are over 45 years take marginally fewer short sick leave periods but take
slightly longer sick days per year than those under 45 years and reflect higher absenteeism
in the age group above 50 years
55
Weeks (200454) found that employees at the age group represented by 51 to 60 years
show less absence which may be because of ill health retirement benefits The age 31 to 40
and 41 to 50 years show higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full time jobs and suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee In the study the age group 55 to 59 years show a decline in absenteeism in
comparison to 50 to 54 while age 60 to 64 shows the lowest rate
The aging employee has been found to expose the institutions to high levels of absenteeism
through a higher probability of becoming incapacitated for longer periods (Ferguson et al
200138) and the current research have pointed differently Rogers and Hertin (1993219)
found a significant correlation between the use of sick leave and age suggesting employees
with advanced age used more sick leave in comparison with the younger employees The
current socio-economic culture encourages retirement from active employment at the age
of 65 years and the research adopted that approach as a cut off point for employment
(Nichols amp Evangelisti 2001285)
TABLE 10 GENDER IN RELATION TO ABSENTEEISM
GENDER TOTAL
NUMBER
DAYS OF
ABSENCE
PERCENTAGE
Males 1006 2490 168
Females 3004 12350 832
Total 4010 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 10 reflects gender in relation to absenteeism The duration of working-man days lost
is higher in female employees at 8325 (n=12350) and is represented by 749 (n=3004) in
relation to the total number of employees in the four hospitals (n=4010) as represented in
table 3 The male employees employed by the Department are reflected as absent from
work by 1680 (n=1006) and represented as 251 in relation to the total number of
employees in the four hospitals (n=4010)
The Public Service Commission (PSC 200222) found that more males took sick leave than
females except for the age group of 16 to 19 years QUALSA (200923) noted that females
had the highest number of incapacity applications in comparison to their male counterparts
Qualsa attributed this pattern to the fact that female employees constitute a higher
percentage of the employee population within the Gauteng Department of Health
56
Roger and Hertin (1993222) noted that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees could have an
impact on the high number of absenteeism reflected by the women
452 Race in relation to absenteeism
The working population of the four hospitals is represented by four race groups such as
Africans Whites Coloureds and Indians
4521 Africans
Africans represent 973 (n=3902) of the total working population (n=4010) and 963
(n=14295) indicates the working-man days lost in relation to the total working-man days
lost (n= 14840) times the percentage 3565 (n= 14295) reflects the working-man days
lost in relation to the total number of employees in the four hospitals (n=4010) The 14295
working-man days lost are multiplied by 8 hours that represent a day and translates into
963 (n=114360) working-man hours lost The cost to the Department is translated as
salary expenditure for n=114360 workingndashman hours lost and the indirect cost of staff
replacement and overtime Africans constitute the highest number of employees as well as
the highest percentage of working-man hours lost Absenteeism percentage is proportional
to the employment figures for this race group
4522 Whites
Whites are represented as 13 (n=51) of the total workforce (n=4010) and 16 (n=242)
represent the working-man days lost in relation to the total working-man days lost
(n=14840) times percentage 61 (n=242) represent working- man days lost in relation to
the total number of employees in the four hospitals The 232 working-man hours lost are
multiplied by 8 hours that represent a working- man day that translates into 16 (n=1856)
working-man hours lost The cost to the Department is represented as salary expenditure of
(n=1856) working-man hours lost that is paid to the unproductive employees This race
group of employees is not represented in all occupational categories and salary ranges
which may explain the low figures and percentages associated with working-man days lost
(n=242) The demographics of the different hospitals may contribute to the low
representation of this group in the total workforce
4523 Coloureds
Coloureds are reflected as 11 (n=43) of the total workforce (n=4010) 14 (n=201)
represent working- man days lost in relation to the total working- man days lost (n=14840)
5 (n=201) indicates working- man days lost in relation to the total number of employees in
the four hospitals (n=4010)
57
The cost to the department is represented as salary expenditure for n=1608 working-man
hours that are lost This race group is represented in three of the four hospitals and not in
all categories and salary ranges which may explain the low representation and
absenteeism
4524 Indians
Indians represent 03 (n=14) of the total workforce (n=4010) in table 6 07 (n=102)
represent working- man days lost in relation to the total working- man days lost (n= 14840)
times percentage 25 (n=102) indicates working- man days lost in relation to the total
number of employees in the four hospitals (n=4010) The 102 working- man days lost are
multiplied by 8 hours that represent a working-man day and translates into 07 (n=816)
working- man hours lost The cost to the Department is expressed as salary expenditure
paid to the unproductive employees for duration of (n=816) working-man hours lost This
race group is not represented in two of the four hospitals in some occupational categories
and salary ranges The Indian race group is represented by the lowest figure of employment
and lowest percentage of leave of absence which is proportional to the employment figure
FIGURE 44 RACES IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 44 reflects the different races in relation to absenteeism The Africans as a race
group is represented by 963 of working-man days lost (n=14840) The high figure of lost
working-man days reflects the demographics of the four hospitals
58
14840 DAYS
(100)
Africans 963
whites 16
coloureds 14
Indians 07
The George Mukhari Hospital is in a semi-rural setting that is predominantly African
populated and employs the highest number of Africans as represented in table 1 (n=2836)
Whites are presented by 16 absenteeism rate and not represented in all occupational
categories and salary ranges which could explain the low figures and percentages associated
with lost working days The absenteeism rate for Indians is represented as 07 and
Coloureds as 14
The Africans as a race group constitute the highest number of employees as well as the
highest percentage of working days lost Absenteeism percentage is proportional to the
employment figures for this race group The Indian race group is represented by the lowest
figure of employment and lowest percentage of leave of absence which is proportional to
the employment figure The South African Survey Millennium (1999-200028) reflected the
African males in 1998 as 354 and females as 348 the Coloured males as 39 and
females as 46 Indian males as 39 and females as 15 and White males as 83 and
females as 94 There has been no significant change in the race group representation in
the working population of the four hospitals
453 Tenure in relation to absenteeism
Tenure in years is grouped in units of ten (10) Tenure in 1 to 10 years 11 to 20 years 21 to
30 years 31 to 40 years of all occupational groups are represented in figure 27 as the total
leave of absence utilised by the full-time employees of different occupational groups in
terms of tenure which translates into n=14840 working-man days lost The lowest hours lost
is at tenure 31 to 40 years of service which is reflected as 59 (n=878) working- man days
lost The highest working-man days lost is at tenure of service of 11 to 20 years reflected as
443 (n= 6577) working- man days lost Tenure of service of 1 to 10 years reflects 30
(n=4451) working-man days lost and tenure of years at 21 to 30 years reflects 198 (n=
2934) working- man days lost
Rogers and Hertin (1993222) express tenure as work experience in years that is viewed as a
predictor of employee productivity where seniority has been found to be inversely related to
absenteeism in terms of frequency and total number of work days lost The Canadian Nurses
Association (20065) suggests that job tenure increases with age as illustrated in their
research where nurses were found to have both job tenure of 20 years or more and are over
45 years of age In the research the tenure of 31 years to 40 years presented with the lowest
absenteeism rate in agreement with Rogers and Hertin (1993222)
59
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 45 reflects the total leave of absence from tenure of 1 year to 40 years The PERSAL
system reflected 40 years as representing more or less 64 years of age and 65 years is the
cut off point for full time employees in the system The lowest working- man days lost is at
tenure of 31 to 40 years of service which is reflected as 590 and represents the older
employee in general The highest working- man days lost is reflected at tenure of 11 to 20
which is presented as 4430 representing the younger employee This is an area of concern
as table 5 reflects professional nursesrsquo absenteeism rate at 208 and administration
support staff at 356 and is possible that the absenteeism rate of the two occupational
categories may be a bigger contributor to the high absenteeism rate reflected in the tenure
of 11 years to 20 years
454 Salary range in relation to absenteeism
The salary range is interpreted in the study as a salary broad band that is represented in
table 9 and ranges from level 1 to 12 Rogers and Hertin (1993 219) claim that the level of
education does seem to have a bearing on the salary range use of sick leave where the
lower level category employees were found to have higher levels of absenteeism than the
higher educated employee The Human Resource Development Strategy (Gauteng Province
200815214) claims that the chances of entering into a higher income bracket in South
Africa rises noticeably after people have twelve years of education The ages 20 to 24 years
are greatly affected by this assumption
60
0
20
40
60
Tenure 1-10Tenure 11-20
Tenure 21-30Tenure 31-40
30 4430
1980
590
Tenure
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 46 above reflects the salary range from 1 to 12 in relation to working- man days lost
as salary range 1 to 2 as n=178 working-man days lost which converts to 12 The highest
absenteeism rate has been noted in the salary range at level 3 to 4 at 3530 (n=5235)
working-man days lost while salary ranges at level 7 to 8 is reflected as the second highest
level of absenteeism at 346 (n=5139) lost working-man days
Salary range at 5 to 6 is reflected as the third highest in absenteeism at 138 (n=2044) lost
working-man days Salary range 9 to 10 is regarded as the entry point to middle
management and is reflected as the fourth highest at 126 (n=1878) working-man days
lost Salary range at 11 to 12 is regarded as middle management entrusted with high levels
of authority and accountability This group is reflected as losing 25 (n=366) working- man
days lost which is considered to be a reasonable low level of absenteeism
455 Age of full time employees in relation to absenteeism
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 years to 55
years as middle-age and shows this group as presenting with a high incapacity leave usage
In the research the age group of 45 years to 49 years is represented with 2235 (n=3318)
working- man days lost and is the highest figure of absenteeism in all age groups
61
178
5235
2044
5139
1878
366
0
1000
2000
3000
4000
5000
6000
Salary range1-2
Salary range3-4
Salary range5-6
Salary range7-8
Salary range9-10
Salary range11-12
DAYS OF ABSENTEEISM
Reday-Mulvey (20057988) and Canadian Nurses Association (20065) observed that
employees over 45 years take marginally fewer short sick leave periods but take slightly
longer sick days per year than those under 45 years and reflect higher absenteeism in the
age group above 50 years
Weeks (200454) claims that the age group at 51years to 60 years show less absence may be
because of ill health retirement benefits The age group of 31 years to 40 years and 41years
to 50 years show a higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full-time jobs He suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee The aging employee has been found to expose the institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods
(Ferguson et al 200138)
Rogers and Hertin (1993219) claim that there is a significant correlation between the use of
sick leave and age suggesting employees with advanced age comparatively used more sick
leave in comparison with the younger employees The current socio-economic culture
encourages retirement from active employment at the age of 65years and the research
adopted that approach as a cut off point for employment (Nichols amp Evangelisti 2001285)
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 47 reflects the number of working-man days lost by full-time employees through
absenteeism related to a specific age
62
16
405
733
1582
2676
3318
3046
2235
829
0
500
1000
1500
2000
2500
3000
3500
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Days of absence
Days of absence
Age groups are organised in units of 5 to be consistent with the Personnel and Salary
Administration System (PERSAL) The age group at 20 years to 24 years reflects the lowest
percentage of absenteeism at 010 (n=16) working-man days lost and the age group of 45
years to 49 years reflect the highest days of absenteeism at 2235 (n=3318)
456 Gender in relation to absenteeism
The females employed in the Department of the four hospitals are represented as 749
(n=3004) in relation to the total number of employees in the four hospitals (n=4010) and
lost 8320 (n=12350) working-man days This absenteeism rate is considered high
considering that not every female employee may have used sick leave The male employees
employed in the Department are represented by 25 (n=1006) of the total workforce
(n=4010) and lost 168 (n=2490) working-man days The findings suggest that males
utilised fewer days of sick leave considering the fact that not every male employee may
have utilised sick leave for the duration of the study
The Public Service Commission (PSC 200222) claims that more males took sick leave than
females except for the age group of 16 years to 19 years QUALSA (200923) noted that
females had the highest number of incapacity applications compared to their male
counterparts Qualsa attributed this pattern to the fact that female employees constitute a
higher percentage of the employee population within the Gauteng Department of Health
Rogers and Hertin (1993222) argue that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees may have an
impact on the high rate of absenteeism
63
FIGURE 48 GENDER IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 48 reflects gender in relation to absenteeism The females employed by the
department in the four hospitals are reflected as absent from work at a rate of 8320
(n=12350) working-man days and represented by 749 (n=3004) in relation to the total
number of employees (n=4010) in the four hospitals The male employees employed by the
Department are reflected as absent from work at 1680 (n=2490) and represented as
251 (n=1004) in relation to the total number of employees in the four hospitals
(n=4010)
457 Week days in relation to occupational groups
Table 11 reflects the trends in terms of days of the week that show high utilisation by the
different occupational groups Mondays Fridays and Thursdays reflect a high utilisation rate
by the employees suggesting a pattern of high absenteeism rate over weekends
Professional nurses and sub-categories and the administration support group reflected the
highest absenteeism over the weekends
64
1680
8320
000
1000
2000
3000
4000
5000
6000
7000
8000
9000
Males Females
GENDER ABSENCE
TABLE 11 WEEK DAYS IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
OCCUPATIONAL
CATEGORY
MONDAY TUESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Doctors 18 8 13 17 0 0
Professional
Nurse
135 86 94 137 0 0
Staff Nurse 52 38 56 65 2 0
Nursing
Assistant
62 27 34 45 2 0
Administration
Staff
64 38 58 73 1 0
Administration
support
252 147 98 126 26 15
Finance officer 17 4 8 16 0 0
TOTAL 600(4) 348(23) 361(24) 479(32) 31(02) 15(010)
(Source Compiled by C S Ndhlovu 2012)
Table 11 reflects the pattern of how the different occupational groups utilised sick leave on
the different days of the week It illustrates the days that sick leave started on each day of
the week The largest number of incidences of sick leave commence on Monday the first
working day of the week as reflected by 4 (n=600) of the days of the weekend Fridays are
the second highest days of absenteeism represented by 32 (n=479) Tuesdays and
Thursday are almost the same in utilisation as reflected by 23 and 24 respectively
Professional nursesrsquo absenteeism was pronounced on Mondays as 2250 (n=135) and
Fridays as 2861 (n=137) a trend that shows possible long weekend absenteeism
The administration support staff has been reflected as mostly absent on Mondays 42
(n=252 days) and Fridays 2631 (n=126 days) The administration support reflected the
highest days of absenteeism on Saturday (n=26) and Sunday (n=15) The Canadian Nurses
Association (CNA) (2006) focused on seasonal pattern of absenteeism in the different
categories in the different hospitals The PSC (2002) report identified a trend by provincial
employees of using sick leave to extend their weekends The research considered working-
man days lost in terms of days of absence as in accordance with evidence of a medical
certificate Administration support is the only group that seem to have utilised Saturdays
for sick leave 8387 (n=26) and Sundays 100 (n=15) days
65
TABLE 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALS
INSTITUTIONAL
CONTRIBUTION
TARA MOROSS
CENTRE
GERMISTON ODI GEORGE
MUKHARI
TOTAL
Contribution to
Sample
668 1070 1182 7080 100
Contribution to
Absenteeism
842 1177 165 7816 100
(Compiled by C S Ndhlovu 2012)
Table 12 reflects the contribution of each hospital to absenteeism Tara Moross Centre
Hospital contributed 67 to the sample and the absence rate is higher than the
contribution at 84 The Germiston Hospital contributed 107 to the sample and the
absenteeism rate is higher at 117 The George Mukhari Hospital contributed 708 to the
sample and absenteeism rate is at 782 and ODI Hospital contributed 118 and
absenteeism rate is at 17 The latter hospital has no computers at The reflection of the
status of absenteeism is likely to be inaccurate The George Mukhari Hospital has the
highest contribution to the sample yet leave of absenteeism is tolerable It raises questions
as to what should be the contributory factor to the leave of absence status in this hospital
46 CONCLUSION
Chapter 4 presented the analysed data in terms of the characteristics as determined in the
stratified random sampling The characteristics and their association with absenteeism have
been presented such as occupational categories age gender tenure of service and race
The research identified which days of the week were utilised for sick leave absence The
contribution of each hospital to absenteeism was identified and a brief overview of each
hospital was presented
Chapter 5 presents the findings conclusion and recommendation of the research
66
CHAPTER 5
FINDINGS CONCLUSIONS AND RECOMMENDATIONS
51 INTRODUCTION
Chapter 1 provides a general introduction to the research It included the background and
motivation for the research that provides the context the problem statement and the
significance of the research The key concepts are defined The research design the method
of data collection the sampling method data analysis and interpretation and limitations to
the research are explained in this chapter
Chapter 2 considers the theoretical foundations concepts characteristics theories
approaches and classifications of workplace absenteeism The discussions on the conceptual
framework of absenteeism predictors of absenteeism and various models of absenteeism
are presented Measures to control workplace absenteeism and the impact of absenteeism
in an institution and management intervention strategies in workplace absenteeism were
discussed
Chapter 3 describes the research design and the different aspects of the research methods
that were applied to the research The chapter explains the various data collection
techniques that are used unit of analysis units of observations construct validity and
ethical considerations
Chapter 4 provides the organisational structure of the Gauteng Department of Health
comparisons of hospital employees different race groups of the four hospitals gender
comparisons in different hospitals and comparisons of the different occupational groups It
provides a short description of the target hospitals The research interpretation is discussed
in terms of the different occupational groups and absenteeism different races and
absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism The trends of week days of
absenteeism in the four hospitals and contributions to absenteeism by the four hospitals are
presented
Chapter 5 explains a synthesis of the study and evaluation of workplace absenteeism The
findings of the research and recommendations are discussed
52 FINDINGS
The findings of the research reflect doctors as represented by 108 in the total workforce
(n=4010) have an incidence of 29 (n=435) of the total work-man days lost (n= 14840) by
the employees in the four hospitals translating to a total of n=3480 working hours lost
67
The working-time lost is considered against the doctorsrsquo workload of 226 in contrast to the
target of as 227 while the national target was 187 The bed occupancy rate target was 75
while the actual figure was 653 The annual report when it is interpreted in conjunction
with the sick leave absence of doctors at 29 shows no negative impact on the workload in
terms of service delivery The negative impact is mainly on the cost factor to the state as the
doctorrsquos salary level is from salary level 10 at a cost of R217482 to salary level 12 at
R407745 (Gauteng Province annual report 2008951) Serneels et al (2008210) claim that
absenteeism occurs primarily in the public sector associated with people who hold two jobs
and that is highest and more frequent amongst doctors The findings of the research of
absence of 29 with a contribution of 2 to the sample are in disagreement with the
Serneels et al findings
Professional nurses represent 196 (n=785) of the total workforce (n=4010) The
workplace absenteeism is represented as 77 (n=3088) of the total workforce (n=4010)
translating into 21 of working-man days that are lost (n=14840) The absenteeism rate
appears to be very high given the fact that nurses by virtue of their numbers are the
backbone of health care service delivery (DPSA 2009) The Gauteng Province annual report
of 2008951 reflects the total vacancy rate of nurses at 697 as against the national target
of 15 The absenteeism rate of 77 is very high when compared with the total vacancy
rate and 19 contribution to the sample Staff nurses are a sub-category of the nursing
profession and the impact of their absence to service delivery is the same as the
professional nurses The findings of the study reflect staff nurses representing 12 (n=482)
of the total working force (n=4010) The absenteeism from staff nurses is reflected as 13
(n=1956) of the total working-man days lost (n=14840) The absenteeism rate does appear
to be high when considering the contribution of 13 to the absence rate by a sample of 12
to the total working-man days lost Nursing assistants are a sub-category of the nursing
profession that is reflected as 107 (n=429) of the total number of employees (n=4010)
and represent 97 (n=1445) of the total working-man days lost (n=14840) This absence
rate is considered as high when compared with the total number of employees
The nursing occupational group considered collectively contributed to absenteeism at the
workplace at 997 which is extremely high Davey and Cummings (2009312-313) claim
that frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased
staff morale and high cost to health care The high absenteeism rate has a negative impact
on health care service delivery
The findings of the research reflect administration staff as 116 (n=466) of the total
number of employees (n=4010) represented by 154 (n=2286 days) of the total working-
man days lost (n=14840) Administration support is at salary level 1 to 2 with exceptional
instances of salary level 3 to 4
68
Administration support staff is reflected as 273 (n=1095) of the total workforce (n=
4010) represented by 356 (n=5289 days) of the total working-man days lost (n=14840)
translating to n=42312 lost working-man hours
The administration staff viewed collectively contributed 51 to absenteeism which is very
high with the support staff reflected as 356 Rogers and Hertin (1993219) claim that the
level of education seem to have influenced the use of sick leave where the lower skilled
category of employees were found to have higher levels of absenteeism than higher
educated or skilled employees The findings of the research reflect the administration
support staff to be in line with the Roger and Hertin findings
The Gauteng Department of Health has a limited number of finance officers causing them to
be a scarce skill occupational group The finance officers represent 2 (n=83) of the total
workforce (n=4010) The working-man days lost are reflected as 23 (n=341) of the total
working-man days lost (n=14840) The total absence at 23 is higher than the actual
contribution to the sample at 2
The age group of 45 years to 49 years reflects the highest absenteeism rate at 224
(n=3318) the age group at 50 years to 54 years is reflected as 205 absenteeism The age
group 40 years to 44 years reflected as 18 absent from the workplace The age group of 55
years to 59 years is reflected as 15 absenteeism Employees of advanced age used more
sick leave in comparison with the younger employees This phenomenon could be attributed
to the ageing process of the body and the onset of incapacity Absenteeism has been found
to be higher in employees who are over 50 years of age and the phenomenon is attributed
to age and changing abilities that increase when work is performed full- time The findings
of the research reflect the age group over 50 years at 205 and reflect the highest
absenteeism rate at age 45 years to 49 years as 224 (McGoldrick amp Arrowsmith 200184
MINTRAC 20093 Nichols amp Evangelisti 2001285 Reday-Mulvey 200579-194) According to
Ferguson et al (200138) the aging employee presents with high levels of absenteeism
through higher probabilities of becoming disabled for longer periods The findings of the
study reflect absenteeism of the age group of 55 years to 59 years at 15 which is the
lowest in the age groups The Canadian Nurses Association in (20065) noted a reduction in
workplace absenteeism rate among nurses who are less than 45 years of age and an
increase in the absenteeism rate among nurses above 55 years of age According to Bangali
(20043-4) the falling rate of the older employee age group could be influenced by the
practice of early retirement or voluntary severance which was used in the 1990s as a
method of restructuring in institutions Rogers and Hertin (1993219) claim employees with
advanced age used more sick leave in comparison with the younger employees
69
The group at tenure 11 to 20 years presented with the highest level of absenteeism at
443 The employee at tenure of 21 to 30 years presented with 198 of absenteeism rate
while the employees at 1 to 10 years presented with the rate of 30 The findings of the
research reflected tenure of 31 to 40 years to have presented with the lowest absenteeism
rate at 59 (n=878 days) This low absenteeism rate could be ascribed to the fact that
numbers of employees are reduced in this group or could also be commitment to their jobs
or could have higher ambition levels to aspire to higher posts
Van Der Westhuizen (2006136) and Rogers and Hertin (1993222) express tenure as work
experience that may be viewed as a predictor of employee productivity where seniority has
been found to be inversely related to absenteeism in terms of frequency and total number
of working-man days lost The public service employees enjoy security of tenure which may
contribute to the unacceptably high levels of absenteeism (Andrews 1997221ndash222
MINTRAC 20093)
The findings of the research reflect females as 75 of the total workforce (n=4010)
represented by 832 (n=12350) of the total working-man days lost (n=14840) The males
represent 25 of the total workforce (n=4010) and are reflected as absent at 168
(n=2490) of the total days of absence (n=14840)The absenteeism rate is very high for
females in this research Rogers and Hertin (199322) and Van Der Westhuizen (2006136)
suggest that women are absent from workplace more than men are Landstad et al (20011)
found that women cleaners who received preventive personnel support depicted a
reduction in absenteeism rate Hoxsey (2010562) claims that although women presented
with a high score of job satisfaction than men they maintained higher levels of
absenteeism MINTRAC (20094ndash8) found that gender moderates the age turnover
relationship Women are more likely to remain in their jobs the older they get than men do
The findings of the research reflect Africans as represented by 26 of the working
population and utilised 963 of the total working-man days lost due to sick leave It is
possible that the overall number of Africans influenced what seems to be a high level of
absenteeism at 963 Whites represented 03 of the working population and
absenteeism is reflected as 16 of the total working-man days lost Coloureds are
represented by 03 of the working-man population and absenteeism was recorded as 14
of the working-man days lost The Indians are represented by 01 of the total working
population and are reflected as 07 of the working-man days lost
The findings of the research reflect the salary range at level 11 to 12 utilised 25 working-
man days for sick leave salary level 7 to 8 which is the supervisory level utilised 346
working-man days lost salary level 3 to 4 which is the entry level of skilled workers utilised
353 working-man days lost The findings suggest management used fewer days of sick
leave in comparison to the supervisory level and entry skilled worker level
70
This can be ascribed to the fact that they are ultimately responsible for the institutionrsquos
effectiveness and productivity
The George Mukhari Hospital contributed 708 to the sample and reflected 771
absenteeism which is relatively low in comparison to the size of the contribution It could be
that processes and procedures of controlling leave of absence are in place The Tara Moross
Centre Hospital contributed 67 to the sample and reflected 93 absenteeism rate that is
high by 26
Professional nurses reflected a trend of high absence over the weekend including
Thursdays This could be a sign of burn out and extending the period of rest from possible
high workloads resulting from high vacancy rates (Gauteng Province annual report 20089)
Nyathi (200059) and the PSC (2002) found that employees are absent from work because
they want to prolong the weekend
53 CONCLUSIONS
The absenteeism rate is very high for females in this research The aging employee presents
with high levels of absenteeism through higher probabilities of becoming disabled for longer
periods The use it or lose it approach of the current system rewards the abuse of sick leave
as it is viewed as not being beneficial by the employees to act responsibly towards the use
of sick leave
The vacancy rate of 697 in the professional nurse category and the absence rate of 208
in 2008 in the four hospitals can only suggest inadequate levels of human resource for
effective efficient quality health care services at a high cost to the Province The nurses
may not be aware of the actual absenteeism or they under-estimate it The combination of
high registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery
Professional nurses and administration support staff have absented themselves from the
workplace predominantly on Mondays and Fridays It could be for various reasons ranging
from feelings of burn out to extending the weekend
The percentage of working-man days lost in relation to the total number of full-time
employees in the four hospitals is reflected as 488 which is very high as there is no
deterrent not to abuse sick leave in the public sector The findings of the research found a
significant correlation between the occupation and use of sick leave age and the use of sick
leave gender and use of sick leave and tenure and use of sick leave
71
The biggest hospital George Mukhari presented the lowest rate of absenteeism for its size
and complexity which reflects an empowered management The Tara Moross Centre
Hospital is the smallest hospital highly specialised and presented with high rate of
absenteeism for its contribution which may be a reflection on the skills of its management
or the type of health care service that is offered by the institution
The international norm of absenteeism is 3 The research established the absence rate at
488 The Gauteng Department of Health is held at ransom by the five trade unions it has
signed agreements with and that makes it difficult for managers to manage absenteeism
The practise of Gauteng Department of Health Head office to remove managers from
institutions when there is a labour unrest exacerbates the problem of managing
institutions
The findings of the research could not establish a representative reflection of race and
absenteeism as Indians Coloured and Whites were not represented in some institutionsrsquo
demographics
54 RECOMMENDATIONS
The White Paper on Transforming Public Service holds management responsible for
delivering specific levels of services and for obtaining value for money in wider utilising of
resources This strategy is to be translated into action The Gauteng Department of Health
should probably benefit by adopting the total absence management philosophy by
cultivating a culture that is not tolerant of high levels of absenteeism through building it in
as a key performance area of the performance of all managers and all employees The
current performance dimension system should lay explicit emphasis on this aspect
The re-engagement of knowledge based and professional retirees at reasonable
remuneration levels to reward their expertise may assist in reviving good work ethics by
mentoring the new and generally young recruits The retired professionals are currently
resisting the call for re-employment on a contract basis at entry level
The Gauteng Department of Health can encourage flexitime in terms of 58 or 68 to allow
the mature employee to remain within the system with the view to share their knowledge
and skills with the young employees who may be highly qualified but lack experience This
approach may deal with the need for adequate human resources for health care delivery at
reduced cost as two employees on flexitime basis can occupy one full-time employeersquos post
Managers should use the return-to-work counselling strategy to solicit feedback from the
employee about the actual absenteeism The counselling should be on a one-to-one basis
This approach may raise self-awareness to the employees in terms of the impact of the
employeersquos absence frothed workplace
72
Currently this intervention strategy is not adequately utilised for fear of confrontation with
labour representatives
Managers should have attendance policies in place effectively communicate policies to
employees adhere to policies and procedures and use absence control strategies
consistently This approach will minimise the feeling of injustice by employees Currently the
human resource unit is challenged by a high staff turnover due to promotions from the
human resource area a situation that creates a vacuum and lack of continuity weakening
the process of empowering line managers by human resource practitioners This high staff
turnover may be controlled through upgrading of the human resource salaries as the
salaries fall out of the occupation service dispensation (OSD)
Managers in the public service are expected to be responsible and accountable for their
portfolios including management of leave of absence and should not shift it to the human
resource unit as is currently the practice It should be possible to charge a manager as an
accomplice for failing to manage the absence of employees where there is no evidence of
corrective remedial action where it has been warranted The researcher takes cognisance of
the fact that the public service is highly unionised and this approach may trigger industrial
action
The employer needs to revive on the job in-service education and training as a way of
imparting institutional values such as attendance at the workplace in partnership with
recognised labour representatives through bilateral and multilateral forums and through
institutional skills development committee which should be representative of all
stakeholders with the view to promote stability in the workplace and indirectly enhance
productivity and reduce workplace absenteeism Currently the bilateral multilateral and
skills development committees are inactive in the institutions that were targeted and
management seems to be intimidated by the militant labour representatives
High levels of absenteeism among some occupational groups do suggest a need for an active
employee assistance programmes at all hospitals Employee wellness committees are
currently inactive There is a sporadic intervention approach at some institutions where
PILIR Committees are active Employee assistance programmes should be budgeted for as a
standing on-going programme in all hospitals There is a need for a thorough research as to
why absenteeism remains high in the public service and focus on absenteeism broadly
73
BIBLIOGRAPHY
African National Congress 1994 A national health plan for South Africa Johannesburg
African National Congress
Allen SG 1984 Trade union absenteeism and exit-voice Industrial and Labour Relations
Review 37 (3 April)
Auriacombe CJ 2001 Guidelines for drawing up research proposals and preparing
thesesdissertations Pretoria University of South Africa
Amin S Das J amp Goldstein M (eds) 2008 Are you being serviced Newtools measuring
service delivery Washington DC The International Bank for Reconstruction and
DevelopmentThe World Bank
Andrews Y 1997 The personnel function University of Pretoria Kagiso Tertiary
Babbie E 1992The practice of social research6th edition California Wadsworth
Bamford L Klein amp Engelbrecht B 1999 How to monitor and address absenteeism in
district hospitals for sub-district support initiative for sub-district support Cape Town
KWIK-SKWIZ 25 Press Gang
Bangali A 2004 Are older workers genuine assets for economy Strategies and possibilities
for effective use of their human resource potentialTuebingen Eberhard Karls University
Barker F2007The South African labour market theory and practice5th edition Pretoria
Van Schaik
Bendix S 2000 Industrial relations in South Africa4th revised edition Lansdowne Juta
Bergdahl M 2001 How-Malrt minimises business with HR practices Human Resource
Development Gauteng College Regional Academy Leadership Journal 6
Breetzke A 2009 Managing absenteeism Available at httpwwwIrnetworkcoza
(Accessed on 05082009)
Brink H 1996 Fundamentals of research methodology for health care professionals
Kenwyn Juta
74
Brynard PA amp Hanekom SX 2005 Introduction to research in Public Administration and
related academic disciplines Pretoria Van Schaik
Burton JP Lee TW amp Holtom BC 2002The influence of motivation to attend and
organizational commitment on different types of absence of behavioursJournal of
Managerial Issues14 (2)
Buschak M Craven C amp Ledman R 1996 Managing absenteeism for productivity SAM
Advanced Management Journal6 (1)
Camp S amp Lambert EG 2005 The influence of organizational incentives on absenteeism
Sick leave use among correctional workers Available on
httpwwweascnoaagov(Accessed on22052009)
Canadian Nurses Association 2006 Trends in illness and injury ndashrelated absenteeism and
overtime among publicly employed registered nurses Canadian Nurses Association Ottawa
Available on httpwwwcna-aiicca (Accessed on 30032009)
Chaudhury Namp Hammer JS 2003Ghost doctors absenteeism in Bangladeshi health
facilitiesWorld Bank Policy Research Working Paper 3065 May Available
onhttpecoworldbankorg(Accessed on 10072011)
Charted Institute of Personnel and Development 2008Absence managementAnnual survey
report Charted Institute of Personnel and Development July Reference 4513 Available at
httpwwwcipdcouk (Accessed on 10072011)
Cloete JJ 2004South African public administration and management2ndimpression
Pretoria Van Schaik
Clark RL 2007The emergence of phased retirement economic implications and policy
concerns Ontario John Deutsch Institute for the study of economic policy
Dagmara S 2000Whorsquos minding the hospitals Absenteeism soars HampHN Hospitals amp
Health Networks 74 (4) April 14ndash143 Available at httpwwwoasisunisaacza(Accessed on
20072011)
Davey MMamp Cummings G 2009 Predictors of nurse absenteeism in hospitals a
systematic review Journal of Nursing Management 17 312ndash330 Available on httpO-
webebscohostcomoasisunisaacza (Accessed on 30072011)
Department for Public Service and Administration1997White paper on transforming public
service delivery Pretoria Public Service Commission
75
Department of Public Service and Administration 2007 Determination on working time in
the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Determination of leave of absence
in the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Policy and procedures on incapacity
leave for ill-health retirement (PILIR)Pretoria National Office
De Wit P 2006 Reasons for absenteeism in the Department of Defence Pretoria Tshwane
University of Technology
Du Toit Damp Van Der Waldt G 1998 Public management grassroots Cape Town Juta
Du Toit D Knipe A Van Niekerk D Van Der Waldt Gamp Doyle M 2001Service
excellence in governance Cape Town Heinemann
Du Toit D Bosch D Woolfrey D Godfrey S Rossouw T Christie S Cooper C Giles
G amp Bosch C 2003Labour relations law a comprehensive guide4thedition Durban
LexisNexis Butterworths
Erasmus B Swanepoel B Schenk H Van der Westhuizen EJamp Wessels JS 2005 South
African human resource management for the public service Pretoria Juta
European Foundation for the Improvement of Living and Working Conditions
(EFILWC)1997Preventing absenteeism at the workplace Ireland Office for Official
Publication on the European Committee
Fakie SA 2005Report on the Auditor-General on a performance audit of the management
of sick leave benefits at certain national and provincial departments Pretoria Department
Public Service and Administration (DPSA)
Ferguson T D Muedder Kamp Fitzgerald R M2001 The case of total absence
management and integrated benefitsHuman Resource Planning24 (3)
Finnemore M amp Van Rensburg R 2002 Contemporary labour relations Johannesburg
LexisNexis
Gaudine A amp Gregory C2010The accuracy of nursesrsquo estimates of their absenteeism
Journal of Nursing Management 18599ndash605
Gauteng Province 2007 Human Resource Development Strategy for Gauteng for Gauteng
maximizing human capital for shared growth Pretoria Government Printers
76
Gauteng Province 20089 Annual report Pretoria Government Printers
Gauteng Province 2010 Monitoring and Evaluation Policy FrameworkGauteng Provincial
Government Office of the Premier
Ghauri P Gronhaug Kamp Kristianslund I 1995 Research methods in business studies
England Prentice-Hall
Goldsmith Mamp Morgan H 2003 ldquoLeadership is a contact sport The ldquofollow up factorrdquo in
management development The 5th Annual Global Learning SummitResearched and
organised by SALVO 20ndash24Feb
Goldstein M2008Why measure service delivery Are you being serviced New tools for
measuring service deliveryEdited byAmin S Das Jamp Goldstein MWashington DCThe
International Bank for Reconstruction and DevelopmentThe World Bank
Griep RH Rotenberg L Chor D Toivanen SampLandsbergis P2010Beyond simple
approaches to studying the association between work characteristics and absenteeism
Combining the DCS and ERI modelsRoutledge Taylor amp Francis GroupWork ampStress 24 (2
April-June)179ndash195Available athttpwwwinformaworldcom (Accessed on 20072011)
Grogan J 2003 Workplace law 7 th edition Lansdowne Juta
Grogan J 2005 Dismissal discrimination and unfair labour practices Lansdowne Juta
Hirschfield RR Schmitt LPamp Bedeian GA2002 Job-content perceptions performance-
reward expectancies and absenteeism among low-wage public-sector clerical employees
Journal of Business and Psychology 16(4) Human Sciences Press Available on
rhirschfterryugaed(Accessed on 30032009)
Hoxsey D2010Are happy employees healthy employees Researching the effects of
employee engagement on absenteeismCanadian Public Administration53 (4) p551-
571Canada The Institute of Public Administration of Canada
Jacobs EJamp Roodt G 2011 The mediating effect of knowledge sharing between
organisational culture and turnover intentions of professional nursesSouth African Journal
of Information Management
Jankowitz E 1991Terminating for absenteeism practical labour management Rivonia IR
Data Publication 1(10)
Keese M2006 Live longer work longerDELSA Newsletter OECD Available at
httpwwwoecdorgelsemployment(Accessed on 10072011)
77
Lambert EG Camp SD Edwards Camp Saylor WG 2005 Here today gone tomorrow
back again the next day absenteeism and its antecedents among Federal Correctional
staffWashington DC Ohio
Landstad B Vinberg S Ivergard TT Gelin G ampEkholm J2001Change in pattern of
absenteeism as a result of workplace intervention for personnel support Ergonomics
001401391544 (1)
LexisNexis 2006Labour Law Reports July 1994ndashDec2006CumulativeIndex Durban
LexisNexis
LexisNexis 2007 Legislation and strategyLexisNexis (9)Durban Butterworths Available at
httpwwwmylexisnexiscoza (Accessed on 15072011)
Madibana LF 2010 Factors influencing absenteeism amongst professional nurses in
London Pretoria University of South Africa
Markussen S Rogeberg OJ amp Gaure S 2009 The anatomy of absenteeism IZA
Discussion Paper Series No 4240 June Bonn Institute for the Study of Labor
McCormick ET amp Ilgen D1985 Industrial and organizational psychology 8th edition New
Jersey Prentice-Hall
McGoldrick E amp Arrowsmith JJ 2001Discrimination by age the organizational response
Ageism in work and employment Edited by Glover IampMohamed Sterling Management
SeriesEngland University of Sterling
Mellor N Arnold Jamp Gelade G2009The effects of transformational leadership on
employees in four of UK public sector organisations Health and Safety Laboratory for the
Health and Safety Executive UK RR648 Research Report
MINTRAC 2009 Literature review on labour turnover and retention Available at
strategieswwwmintraccom (Accessed on 14042009)
Mouton J2005How to succeed in your Masterrsquos and Doctoral studies a South African guide
and resource book Pretoria Van Schaik
Munro L 2007 Absenteeism and presenteeism possible causes and solutions The South
African Radiographer45(1) Available onhttpsorsaorgza(Accessed on 10072011)
Nel PS Gerber PD Van Dyk PS Haasbroek GD Schultz HB Sono TampWerner A
2001 Human resource management5th edition New York Oxford
Nel PS Kirsten M Swanepoel BJ Erasmus BJampPoisant P 2008South African
employment relations theory and practice6th edition Pretoria Van Schaik
78
Nichols AampEvangelisti W2001 Fitness for work the effect of aging and the benefits of
exerciseSterling management series ageism in work and employmentEdited by Glover
LampMohamed B England University of Sterling
Nyathi MN 2000Factors contributing to absenteeism among nurses a management
perspective Pretoria University of South Africa
Patrick MN 2001Positive psychological functioning among civil servantsPretoria
University of South Africa
Paton N2010 Long-term absence hand in hand Occupational Health Reed Business
Information UK Reed Elsevier Available athttpebscohostcomoasisunisaacza
(Accessed on 10072011)
Parbhoo S2003 Why worry about absenteeism in the workplace CCMA PublicationCCMA
Mail July
Pierce K2009 The impact of absenteeism in the public service in the context of GEMS
Pretoria GEMS Government Employees Medical Scheme [lsquoslrsquo]
Public Service and Co-ordinating Bargaining Council (PSCBC) 2000Resolution 72000
Polit DF amp Hungler BP 1995 Nursing research principles and methods Philadelphia
Lippincott
Pousette A amp Hanse JJ 2002Job characteristics as predictors of ill-health and sickness
absenteeism in different occupational types-a multigroup structural equation modelling
approachNational Institute for working life TaylorampFrancisSweden Goteborg Available on
httpwwwtandfcouk (Accessed on 10072011)
Public Service Commission2002Sick leave trends in the Public Service Pretoria Public
Service Commission
QUALSA Report 2009Policy procedure incapacity leave and ill-health retirement Steering
Committee QUALSA [rsquoslrsquo]
Reday-Mulvey G 2005Working beyond 60 key policies and practices in Europe New York
Palgrave Macmillan
Republic of South Africa 1995 Labour Relations Act 66 of 1995
Republic of South Africa 1997 Basic Conditions of Employment Act 75 of 1997
Republic of South Africa 2001 Public Service Regulation 2001
79
Republic of South Africa 2011 ldquoTowardsquality care for the patientrdquo National Core
Standards for Health Establishments in South Africa Pretoria Government Printers
Robbins SP amp Decenzo DA 2001 Fundamentals of management essential concepts and
applicationsNew Jersey Prentice Hall
Robbins SP Odendaal A amp Roodt G2004Organizationalbehaviour Global Southern
perspective 5th impression Cape Town Pearson
Rogers RE amp Hertin SR 1993Patterns of absenteeism among government employees
Public Personnel Management22 (2)Available at httpwwwquestiacom (Accessed on
10012009)
Serneels P Lindelow MampLievens T2008Qualitative research to prepare quantitative
analysis absenteeism among health workers in two African countriesAre you being
serviced New tools for measuring service deliveryEdited by Amin S Das
JampGoldsteinM2008 The International Bank for Reconstruction and DevelopmentThe
World Bank for Reconstruction and Development Washington D C The World Bank
Slabbert JA amp Swanepoel BJ 2001Introduction to employment relations
managementDurban Butterworths
South African Survey Millennium1999-2000 Johannesburg South African Institute of Race
Relations
Steers RMamp Rhodes SR 1978Major influences on employee attendance a process
model Journal of Applied Psychology63 (4)391-407
Oi-ling S2002Experience before and throughout the nursing careerPredictors of job
satisfaction and absenteeism in two samples of Hong Kong nursesJournal of Advanced
Nursing 40 (2)218ndash229 Available on httpwwwebscohostcomoasisunisaacza
(Accessed on 10072011)
Todd C2001Contract of employment Claremont Siber Ink
Tonya TW2001Minimizing absenteeism in the workplace strategies for nurse managers
Nursing Economics19 (2 MarApril) 53 3 Available at httpwwwoasisunisaacza
(Accessed on 14012009)
Tustin C 1994Industrial relations a psychological approach1st edition Halfway House
Southern Publishers
80
Unruh Jamp Strickland M2007 Nurse absenteeism and workload Negative effect on
restraint use incident reports and mortality JANORIGINAL RESEARCH Journal compilation
Florida Blackwell
Van der Westhuizen C 2006Work related attitudes as predictors of employee absenteeism
Pretoria University of South Africa
Venter R 2003 Labour relations in South AfricaRevised edition Cape Town Oxford
University Press
Viviane IJ 2011Absenteeism among women workers in industry85 IntrsquoLab Rev 248
(1962) Available at httpwwwHeinonlineorg(Accessed on 18052012)
Weeks KL 2004 Development and initial characteristics of a comprehensive survey on
workplace absenteeism Logan Utah State University Available on
httpwwwoasiscomunisaacza(Accessed on 14012009)
Welman JC amp Kruger SJ2001Research methodology for the business and administrative
sciences 2nd edition New York Oxford
Yende PM 2005 Utilising employee assistance programmes to reduce absenteeism in the
workplace JohannesburgUniversity of Johannesburg
81
ANNEXURES A B C
ANNEXURE A
PROCESS EVALUATION QUESTION COMPLIANCE
YESNO
ACTION PLAN
Retention and Reward -
leave
1 Are there complete and
accurate Z 1(Leave application
forms) forms on file
2 Have all application forms been
approved stamped and
registered
3 Have all forms been captured
on the Persal with the following
requirements
Supporting documents
A 10 day compulsory leave
processed within the annual
leave cycle Determination of
Leave
4 The remaining days are utilized
6 months from the end of the
leave cycle
5 Are there unutilized leave days
6 Has there been adequate
checking of leave reasons
Leave credits
Adherence to leave categories
(i)Normal ( ii) Incapacity
(iii) Injury on duty (iv) Maternity
(v)Adoption (vi) Family
responsibility
(vii) Office bearersshop stewards
and Casual Employees
7 Have work reasons been
provided for leave days
(Source Compiled by C S Ndhlovu 2012)
82
ANNEXURE B
Retention and
reward ndashsick leave
Evaluation Question Compliance YesNo Action Plan
1 Are there medical
certificates that have been
submitted to all medical
claims with the following
Specific illness stated
Supporting documents on
file
2 Has the 8 week rule for
36 days in a 3 year cycle
been adhered to
3 Are there complete
medical certificates for 3
days or more sick leave
days for normal sick leave
4 Are all other leave days
above 3 days utilized after
36 days treated as
temporary incapacity
leave
5 Are temporary
incapacity leave forms
submitted within 5 working
days after the first day of
absence
6Is there a register for
temporary incapacity
leave for 1 to 29 days lead
time for reporting leave
applications
7 Has the employer
approveddeclined the
leave application within 30
working days of receipt
(Source Compiled by C S Ndhlovu 2012)
83
ANNEXURE C
CHECK LIST
Is there a leave register in place for all leave applications
1 Is leave approved prior to the employee proceeding on leave
2 Area attendance registers maintained and up to date
3 Are periodic audits for leave carried out
4 Is there evidence of GSSCrsquos approval on leave applications
5 Are leave forms accurately captured on Persal
6 Are leave forms accurately completed by applicants
7 Is movement of leave forms monitored between the GSSC and institutions
8 How is rejected leave application dealt with
(Source Compiled by C S Ndhlovu 2012)
84
GLOSSARY
ANC = African National Congress
BCEA=Basic Conditions of Employment
CNA=Canadian Nurses Association
CAT= Catastrophic Model
CIPD= Charted Institute of Personnel Development
CCMA = Commission for Conciliation Mediation and Arbitration
CSRS=Civil Service Retirement System
DPSA=Department of Public Service and Administration
EAP= Employee Assistance Programme
EFILWC=European Foundation for the Improvement of Living and Working Conditions
FERS=Federal Employees Retirement System
GDoH=Gauteng Department of Health
GHP=Gross Health Product
HRIM=Human Resource Information Management
HRDS=Human Resource Development Strategy
RSA=Republic of South Africa
PILIR=Policy and Procedures on Incapacity Leave for Ill-Health Retirement
PERSAL= Personnel Remuneration Administration System
PSCBC=Public ServiceCo-ordinating Bargaining Council
PTO= Paid Time off Model
PSC= Public Service Commission
SACOB=South African Chamber of Business
V
Table of Contents
1 CHAPTER 1 GENERAL INTRODUCTION 1
11 INTRODUCTION 1
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH 1
13 PROBLEM STATEMENT 2
14 AIM AND OBJECTIVES OF THE RESEARCH 2
141 Aim 2
142 Objectives 2
15 LITERATURE REVIEW 3
16 TERMINOLOGY 3
17 RESEARCH DESIGN AND METHODOLOGY 4
171 Research design 4
172 Methodology 5
173 Unit of analysis 7
174 Unit of observation 7
18 CONSTRUCT VALIDITY 7
19 ETHICAL CONSIDERATION 7
110 LIMITATIONS OF THE RESEARCH 8
111 STRUCTURE OF THE RESEARCH 8
112 REFERENCE TECHNIQUEhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip9
113 CONCLUSION 9
2 CHAPTER 2 MANAGING ABSENTEEISM 10
21 INTRODUCTION 10
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM 10
221 Classification of absenteeism 15
222 Definition of key concepts 15
23 EMPLOYMENT RELATIONSHIPS 17
231 Employment relationship as a multi-dimensional phenomenon 17
2311 Economic dimensions 17
2312 Legal dimension 18
2313 Individual dimension 18
2314 Collective dimension 19
2315 Psycho-social dimension 19
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM 19
25 PREDICTORS OF ABSENTEEISM 20
26 A MULTI-GROUP INVARIANCE MODEL 22
27 CATASTROPHIC MODEL (CAT) 24
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM 24
VI
281 Measuring absenteeism 25
29 IMPACT OF WORKPLACE ABSENTEEISM 25
291 Cost to the institution 26
292 Low productivity 27
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM 27
2101 Effective communication 28
2102 Empowerment of managers 28
2103 Monitoring of workplace absenteeism 29
2104 Visits to facilities 30
2105 Incentive system 30
2106 Team support 31
2107 Return-to-work interviews 31
2108 Employee assistance programme (EAP) 32
2109 Occupational and safety committee 32
21010 Review committeehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip33
211 CONCLUSION 33
3 CHAPTER 3 METHODOLOGY IN RESEARCH 34
31 INTRODUCTION 34
32 RESEARCH DESIGN 34
321 Methodology 34
33 UNIT OF ANALYSIS 36
34 UNIT OF OBSERVATIONS 36
35 CONSTRUCT VALIDITY 36
36 ETHICAL CONSIDERATIONS 37
37 CONCLUSION 37
4 CHAPTER 4 INTERPRETATION AND ANALYSIS OF DATA 38
41 INTRODUCTION 38
42 THE STRUCTURE OF THE ORGANISATION 38
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY 39
44 COMPARISON OF HOSPITALS PERMANENT EMPLOYEES 40
441 The Tara Moross Centre Hospital 46
442 The Germiston Hospital 46
443 The ODI District Hospital 46
444 The George Mukhari Hospital 46
45 RESEARCH INTERPRETATION 47
451 Occupational groups in relation to absenteeism 49
4511 Doctors 50
4512 Professional nurses 51
4513 Staff nurses 51
VII
4514 Nursing assistants 51
4515 Finance officers 52
4516 Administration staff 52
4517 Administration support 52
452 Race in relation to absenteeism 57
4521 Africans 57
4522 Whites 57
4523 Coloureds 57
4524 Indians 58
453 Tenure range in relation to absenteeism 59
454 Salary range in relation to absenteeism 60
455 Age of full time employees in relation to absenteeism 61
456 Gender in relation to absenteeism 63
457 Week days in relation to occupational groups 64
46 CONCLUSION 66
5 CHAPTER 5 FINDINGS CONCLUSIONS AND RECOMMENDATIONS 67
51 INTRODUCTION 67
52 FINDINGS 67
53 CONCLUSIONS 71
54 RECOMMENDATIONS 72
BIBLIOGRAPHY 74
ANNEXURES A B Chelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip82
VIII
LIST OF FIGURES
FIGURE 21 CONCEPTUAL FRAMEWORK MODELhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
FIGURE 22 MODEL SPECIFICATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
FIGURE 41 INTEGRATED ORGANISATIONAL STRUCTUREhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip53
AS REPRESENTED BY THE HOSPITALS
FIGURE 44 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip58
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip60
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip61
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALShelliphelliphelliphelliphellip62
FIGURE 48 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip64
X
LIST OF TABLES
Table 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
Table 2 COMPARISONS OF NUMBERS OF ADMINISTRATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
AND SUPPORT STAFF IN THE DIFFERENT HOSPITALS
Table 3 GENDER COMPARISON IN DIFFERENT HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Table 4 COMPARISON OF TENURE OF SERVICE IN RELATION TOhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
ABSENTEEISM IN THE FOUR HOSPITALS
Table 5 COMPARISON OF THE OCCUPATIONAL GROUPShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip45
IN THE DIFFERENT HOSPITALS
Table 6 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip48
Table 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Table 8 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip54
(SALARY RANGE 1-12)
Table 9 AGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip55
Table 10 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Table 11 WEEK DAYS IN RELATION TO ABSENTEEISM INhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip65
THE FOUR HOSPITALS
Table 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphellip66
IX
CHAPTER 1
GENERAL INTRODUCTION
11 INTRODUCTION
The Gauteng Province is viewed as a province of opportunities by South Africans as well the
neighbouring countries such as Mozambique and Zimbabwe The impact of these
perceptions has placed a heavy demand on services including health provided within the
confines of the province the results being an increase in the workload of the employees
The indirect results of the increase in the workload have been unacceptably high levels of
absenteeism seemingly sub-standard levels of health care and high cost of delivering the
health care services Absenteeism poses a threat and can lead to the collapse of health care
services if absenteeism is poorly managed The research examines the management and
control of absenteeism in four out of thirty four hospitals that service the province The
hospitals that have been targeted for the research are ODI District Hospital Germiston
Hospital TARA Moross Centre Hospital and George Mukhari Hospital
This chapter explains the background and motivation for the research The research
highlights the problem statement which focuses on the effective management of
absenteeism The objectives of the study the research methodology and structure of the
research are explained The relevant literature review was consulted for the research The
key concepts that are used in the research are conceptually defined The research design is
a descriptive stratified random survey The data that were used were collected in three
phases the unit of analysis were the employees of the Gauteng Department of Health in the
four target hospitals and the unit of observations were observations of the employees of
the four hospitals The construct of validity was achieved through using a variety of data
collection methods Ethical considerations were taken into account during the research
process Limitations of the research were imposed by the uniqueness of each of the target
hospitals The structure of the research and the reference technique is explained in this
chapter The research on absenteeism in the Gauteng Department of Health is confined to
the period of 1 January 2008 to 31 December 2008 and focused on the working-man days
lost how absenteeism is managed and employee well-being and rehabilitation
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH
The Gauteng Department of Health received a qualified report in 2008 on the control of sick
leave A performance audit was conducted by the Public Service Commission (PSC) (2002
xvi) into the information required to effectively manage sick leave in the public service
1
The research on absenteeism in Gauteng Department of Health seeks to examine the extent
of workplace absenteeism in the ODI District Hospital which is in a transitional stage from
North West to the Gauteng Province The hospital falls under Tshwane Metropolitan
Municipality and is in Region C The Germiston Hospital falls under Ekurhuleni Metropolitan
Municipality in Region B TARA Moross Centre Hospital is in Region A under the
Johannesburg Metropolitan Municipality and George Mukhari Academic Hospital is Region C
under the Tshwane Metropolitan Municipality The research seeks to examine the degree of
compliance by the four hospitals with the recommendations of the performance audit of
management of sick leave in the light of the qualified report received by the Gauteng
Department of Health (Human Resources) in 20089
13 PROBLEM STATEMENT
The Gauteng Department of Health provides health care services as the core business of the
Department The Health care services are labour intensive and high levels of absenteeism by
its employees undermine the Departmental efforts to deliver quality health care to the
people of Gauteng The problem statement therefore is to examine to what extent the
effective management of absenteeism can enhance the effectiveness of the Gauteng
Department of Health
14 AIM AND OBJECTIVES OF THE RESEARCH
The aim and objectives of the research are explained in this section
141 AIM
The aim of the research is to determine how the effective management of absenteeism can
contribute to the effective health care of Gautengrsquos communities
142 Objectives
The objectives of the study are
to determine the impact of the variables such as age gender occupational category
and salary level on workplace absenteeism
to determine whether the correlation between absenteeism levels and tenure of
service does exist
to determine trends of workplace absenteeism in different employee categories and
to establish the different challenges confronting the different hospitals in
management and control of absenteeism in terms of size complexity and location
2
15 LITERATURE REVIEW
Various studies have been conducted to examine workplace absenteeism in different fields
in government and private institutions Van Der Westhuizen (200636) research focused on
high and low combinations of job involvement and organisational commitment The
outcome was not emphatic on the findings as predictors of the turnover and absenteeism
The research noted that women are more absent from the workplace than men De Wit
(2006) focused on the nature of absenteeism the impact of absenteeism on the
organisation reasons for and causes of absenteeism and measurement of absenteeism and
the findings were not able to find a high coefficient in the test sample
Camp and Lambert (20054) found that the use of sick leave as an incentive to reduce sick
leave by the employees under the Civil Service Retirement System (CSRS) led to a reduction
of absenteeism as a result of sick leave when compared with employees who functioned
under the conditions of the Federal Employees Retirement System (FERS) who within the
same company lost the unused sick leave when they retired
Ferguson Ferguson Muedder and Fitzgerald (200138) focused on the impact of
absenteeism and cost in terms of time lost in the Total Absence Management (TAM)
concept and found that the aging employee exposes institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods of
time
Serneels Lindelow and Lievens (2008210) claim absenteeism is high among employees in
the public sector in developing countries due to a lack of accountability and a lack of
punishment for transgression
The research seeks to determine the extent of the problem of workplace absenteeism its
impact and management in the identified hospitals It seeks to establish the relationship if
any between the various variables and absenteeism such as age occupation tenure salary
level gender and race
16 TERMINOLOGY
Key concepts that are used in the research are conceptually defined however a
comprehensive concept clarification will be done in chapter 2
Workplace absenteeism Workplace absenteeism is the absence of employee at the
workplace that is defined by Du Toit and Van Der Waldt in (1998139) as the place that the
institution makes available and where officials have to perform their work
3
Workplace forms part of the internal environment for public administration in the public
service Robbins Odendaal and Roodt (200415) define absenteeism as the failure of an
employee to report for work as scheduled regardless of the reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work According to
Venter (2003267) desertion occurs when the employee leaves the place of employment
without the intention to return to work
Employee An employee is defined as any person employed in terms of the Public Service
Act 1994 irrespective of rank or position (Public Service Act 1994 Subsection 15) Todd
(20011) refers to an employee as any person excluding an independent contractor who
works for another person and is entitled to be paid for it or who in any manner assists in
carrying on or conduct the business of the employer Bendix (2000123) defines an
employee as a person in a workplace except a ldquosenior managerial employeerdquo whose status
and contract of service grants the employee the authority to represent the employer in
interactions with the workplace forum to determine policy on behalf of the employer and
make decisions which might conflict with representation of workers at the workplace
Employer An employer as an individual person who may be the employer in legal terms as
well as the organisation which is responsible for implementing Public Service human
resource management policies (RSA 1997 Section 15)
Leave cycle The Public Service Act 1994 refers to the leave cycle as 36 months employment
with the same employer
Quality Is defined as getting the best results possible within the available resources (RSA
2011)
Standard Is a statement of an expected level of quality delivery A standard reflects the
ideal performance level of a health establishment in providing quality care (RSA 2011)
17 RESEARCH DESIGN AND METHODOLOGY
This section deals with the research design and methodology
171 Research design
Research design is the overall plan for relating the conceptual problem to relevant empirical
research It is a quantitative descriptive research that involves the systematic collection of
numerical information under conditions of considerable control (Polit amp Hungler 1994
24175)
4
The choice of the research design influences subsequent research activities such as
identifying the target subjects what data to collect and how they should be collected The
research design is a descriptive stratified random survey which is concerned with
characteristics of a specific population subject at a fixed point in time for comparative
purposes The focus is on a representative sample of the relevant population It is concerned
with the accuracy of the findings and their generalisability The survey is used to gain deeper
insight of the behaviour of employees with regards to motivation satisfaction and
grievances (Babbie 199289 Ghauri Gronhaug amp Kristianslund 199527 60 Brink 199611
6 Welman Kruger amp Mitchell 200152)
172 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services Four hospitals of the thirty four health care delivery institutions have been
identified for the research
Each hospital is unique in its character in terms of specialisation of health care delivery
service The four hospitals are located in Tshwane Johannesburg and Ekurhuleni
Metropolitan Municipalities The sample is a stratified random sampling which is composed
of various clearly recognisable non-overlapping sub-populations (strata) that differ from
one another mutually in terms of variables that are a combination of more than one
variable such as age sex income level or educational level The purpose is to ensure that
every part of the population (every stratum) is represented The members of a particular
stratum are homogeneous in the population at large The sample is representative of a
population with clearly distinguishable strata with a greater degree of certainty (Babbie
199267 Brynard amp Hanekom 200544 Ghauri et al 199578 Brink 1996138 Welman amp
Kruger 200155-56 Welman et al 201061 Polit and Hungler 199518) The data were
collected in three phases
The first phase of data collection was done through auditing of hard copies of identified
personnel files representing ten files per hospital and using the tool in annexure A amp B The
forty employeesrsquo profiles were accessed through the Human Resource Information
Management system (HRIM) located in the Gauteng Department of Health Head Office The
respective employeesrsquo profiles were handed over to the human resource manager in the
respective hospitals on the morning of the audit for the human resource practitioner to
draw out the hard copy files for auditing The characteristics of the individuals that were
identified for the first phase were males and females and the different race groups The
auditing of the files was for the complete working life of the employees and not confined to
2008 only Registers that are used by the human resource administration to control the
movement of the leave forms were inspected as evidence of the control system in place
5
The purpose of auditing the files is to gain insight into how leave in general was captured
managed and controlled by the hospitals The second phase of data collection was done
through structured interviews with the four human resource managers who were directly
accountable for management and control of leave of absence in general in the four
hospitals
A structured interview provides for a more organised approach and a more stable basis for
assessment of the different candidates (Erasmus Swanepoel Schenk Van der Westhuizen amp
Wessels 2005250) The structured interview was conducted using the tool in annexure C
Tara Moross Centre Hospital had been functioning without a manager in human resource
and the manager that was interviewed had been in the post for three months The human
resource practitioner who was at salary level 8 acting in the Assistant Directorrsquos post
(manager) was invited to join the manager and be part of the structured interview ODI
District Hospital had three human resource practitioners including the accounting officer at
level 8 and in an acting capacity
The third phase of data collection was through the Human Resource Information
Management (HRIM) This system used Personnel Remuneration Administration System
(PERSAL) to collect data Data in this system are categorised in salary level date of
appointment occupational category gender age in units of five race employing hospital
employment status in different categories such as session contract and full-time and the
different types of leave of absence
The research used primary and secondary data in analysing sick leave utilised by full time
employees in the identified hospitals for the period of 1 January to 31 December 2008 using
the Personnel Remuneration Administration System The total population sample was four
thousands and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range at level 1 to 12
The research used past events such as sick leave utilised by employees using secondary
data from Personnel Remuneration Administration System falling into the category of a
historical empirical research The interval scale of measurement was used in the
quantitative research and actual numbers are ordered with equal measurement between
each category (Brink 1996 149 Brynard amp Hanekom 2005 28-29 Mouton 2005
52100170)
6
173 Unit of analysis
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the research refers to observation of work attendance by
the employees of Gauteng Department of Health in the four hospitals
The observation deals with the historical events such as employees who have already
utilised sick leave in the workplace The subjects that are studied are the core health care
providers such as doctors nurses and support employees such as allied administration and
administration support (Mouton 200551-52 Welman et al 2001 52-53)
174 Unit of observations
The observations that are made are of health care workers and support teams in Tara
Hospital Germiston Hospital ODI Hospital and George Mukhari Hospitals The unit of
observations describes the characteristics of a large number of individual people such as
gender age salary range occupational category tenure of service and race in relation to
absenteeism in the workplace In the descriptive research the individual characteristics are
aggregated for the purpose of describing a larger group (Babbie 199292)
18 CONSTRUCT VALIDITY
Construct validity is concerned with the question what construct is the instrument actually
measuring(Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with the four accounting officers in leave management The third phase was collecting of
personnel data through the Persal system
19 ETHICAL CONSIDERATIONS
Ethical considerations included among other issues the protection of the unit of analysis and
unit of observations from discomfort and harm by not revealing information which can
cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity Anonymity is achieved
when the researcher cannot link a given response with a given respondent and reporting
aggregate data only When data are collected at one sitting and not over a period of time
makes it possible to achieve anonymity as the need for follow up is eliminated Subjects of
observations are selected for reasons directly related to the problem being studied as the
principle of justice
7
Confidentiality is about the researcherrsquos responsibility to protect all data gathered within
the scope of the research and shared only with people involved in the research (Babbie
1992465ndash466 Brink 199640ndash41 45)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous The interview was part of the actual audit
that was done as part of monitoring and evaluation that was in progress in the Department
of Health following a negative auditor generalrsquos report about management of leave in
general The managers were put at ease as they were given the check list afterwards for
self-monitoring for future self-auditing
The data that were collected through Personnel Remuneration Administration System
(Persal) identified employees through the Persal number and kept their identity anonymous
The data that were collected through the hard copy of employeesrsquo files were used to point
out areas of concern to the managers and the files did not leave the office of the manager
at the end of the process once more protecting the identity of the employee
110 LIMITATIONS OF THE RESEARCH
The research was conducted on four hospitals of different sizes specialisation and three
metropolitans with unique challenges The period of the research was confined to a
calendar year (2008) and not a financial year The focus was on absenteeism due to sick
leave of full time employees There is no distinction that is drawn between the working-man
days that are lost between shift and non-shift workers The findings may be different if all
absenteeism of employees at the time were considered for the research
111 STRUCTURE OF THE RESEARCH
Chapter 1 It provides a general introduction to the research It includes an introduction the
background and motivation for the research that provides the context the problem
statement and the significance of the research The key concepts are defined The research
design the method of data collection the sampling method data analysis and
interpretation limitations to the research are explained in this chapter
Chapter 2 This chapter considers the theoretical foundations concepts characteristics
theories approaches and classifications of workplace absenteeism Conceptual framework
of absenteeism predictors of absenteeism and various models of absenteeism are
explained Measures to control workplace absenteeism the impact of absenteeism in the
institution and management intervention strategies are explained
Chapter 3 It describes the research design different aspects of the research methods
applied and the data collection techniques used unit of analysis units of observations
construct validity and ethical considerations
8
Chapter 4 This chapter provides the organisational structure of the Gauteng Department of
Health comparisons of hospital employees different race groups of the four hospitals
gender comparisons in different hospitals and comparisons of the different occupational
groups It provides a short description of the target hospitals The research interpretation is
discussed in terms of the different occupational groups and absenteeism different races
and absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism
The week days absenteeism pattern and contributions by the four hospitals to absenteeism
are presented in this chapter
Chapter 5 It provides a discussion of the research evaluation of workplace absenteeism
findings recommendations and limitations
112 REFERENCE TECHNIQUE
The reference technique that is applied in the research involves all sources that have been
consulted while doing the research When legislation is used as a source of information
reference to the specific act is used
113 CONCLUSION
Chapter 1 provides a discussion on the background and motivation of the research problem
statement and the objectives The significance of the research in South African public
institutions and private institutions of other countries and the possible contribution of the
study are explored The terminology that is used in the research is contextualised for the
purpose of the research The research design and methodology are presented in this
chapter The units of analysis the units of observation construct validity ethical
considerations and limitations to the research are also presented in this chapter
The next chapter discusses the theories of absenteeism
9
CHAPTER 2
MANAGING ABSENTEEISM
21 INTRODUCTION
The Gauteng Department of Health is classified as a public institution whose existence is
justified on the grounds that it renders health care services to the public The health care
system is encouraged to develop delivery systems and practices that are in line with
international standards management practices that promote efficient and compassionate
delivery of services and ensures respect for human rights and accountability to the public
(African National Congress 199443-44) This objective can only be achieved if the resources
to provide such services are available The human resources are a vital factor for the health
care sector as it is labour intensive Public institutions such as the Gauteng Department of
Health are funded from public funds and if the human resources do not report for work
service delivery is compromised and the cost to the department in the form of salary
expenditure becomes exorbitant as the department must find replacement staff and pay
for overtime as well It is when all these factors are taken into consideration that workplace
absenteeism becomes a cause for concern for the Gauteng Department of Health
In this chapter absenteeism is discussed from a theoretical perspective and informed by
literature review The classification of workplace absenteeism theoretical perspective
definitions dimensions of employment relationship conceptual framework of absenteeism
structural model of absenteeism legislative framework that regulates the employment
relationship and intervention strategies to control workplace absenteeism are explored
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM
According to Viviane (20111) the term absenteeism was first used in Britain during the
First World War in dealing with employed persons It is during the times when production is
of pressing national importance that the absence of employees from the workplace is keenly
felt Absenteeism is considered a good barometer of staff morale an indirect measure of
employeesrsquo health and well-being and is found to be associated with health-related
absences from work Employees who are motivated and committed to their work and
employer have to be very sick before they book off sick (Griep Rotenberg Chor Toivanen amp
Landsbergis 2010179)
McCormick and Ilgen (198556-57) describe job attendance criteria as relating to a tendency
of employees to withdraw from or attend to their jobs The criteria identified were job
tenure occupational category absenteeism and tardiness According to Markussen
Rogeberg and Gaure (20096) employee characteristics such as age gender education and
occupation have a substantial impact on absence behaviour
10
Chaudhury and Hammer (20033) identified that medical skills and nursing skills are
marketable and greatly in demand Doctors and nurses used this opportunity to make
money and work as private health care providers as well as public health care providers
holding two jobs The absence is considered in terms of morning or afternoon absence by
these categories as they are viewed as having a great deal of discretion over where and
when to discharge their public responsibilities The criteria identified were job tenure
absenteeism and tardiness
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) refer to absenteeism
as non-attendance when an employee is scheduled to work The theoretical perspective of
absenteeism takes into account the physical and or psychological absence of the employee
from the workplace or work station at a time when the employee is contractually expected
to be at the workplace According to Andrews (199734-35) the behaviour and actions of
public officials are determined by specific ethical codes of conduct and it is assumed that
their actions are for the benefit of the communities that are serviced by the public officials
Social ethics focus on how the clients of the Department are treated and are therefore
concerned with the impact of decisions on people inside and outside the institution
individually and collectively
Grogan (2005237) states that employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
look for trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
2001 section F(c) In the public sector contractual employee benefits are modified by
collective agreements These benefits are material gains for the employees and have a
monetary value and a cost factor to the employer
The contract of employment often includes insured benefits such as incapacity ill health
and early retirement as the total package other than the remuneration for the time worked
as it is intended to attract retain and motivate employees (Breetzke 20091 Ferguson et al
200137 LexisNexis 2006670 LexisNexis 2007176 Markussen Rogeberg amp Gaure 20093
Tustin 199452) The policy on Determination on Leave of Absence requires a medical
certificate for sick leave of three or more days and for every sick leave day utilised when the
eight week rule has been transgressed (DPSA 2009 Section 14 subsection 147)
Political ideologies influence the work environment resulting in some areas being highly
unionised where unions are perceived to be capable of exerting control over the employer
and employee relations for the primary benefit of the employees
11
It is the work environment which is highly unionised that is characterised by high workplace
absenteeism (Andrews 199736 Breetzke 20091 Du Toit amp Van Der Waldt 1998170139
Tustin 199452) Allen (1984331) claims that union members might be absent more
frequently from the workplace than non-members because they face smaller penalties for
absenteeism According to Markussen et al (20095 21) workplace environments do have an
impact on absenteeism and are influenced by social interaction processes among
colleagues Absenteeism is affected by social norms Workplaces with high employee
turnover rate tend to have high absenteeism The turnover rate is defined on a quarterly
basis as Min (number of entries number of existing persons) divided by the number of
employees at the start of the quarter The Charted Institute of Personnel and Development
(CIPD) (200811) claim that the 2006 survey of absence management portrays the public
sector employees as less likely to be dismissed for reasons of workplace absenteeism A
report by the National Institute of Labour Studies (Tonya 20011) found the rate of
absenteeism increased among full-time employees from 2 4 to 25 within two years
The services that are provided by the Department of Health are divided into two distinct
categories Direct services are those services that are rendered to the clients who are
patients who receive medical treatment from the core employees usually referred to as line
functionaries Direct services can only become effective and efficient when supported by
the services of the support staff that provide indirect health care services When employees
do not present themselves for work when scheduled to work and do so on a regular basis
the situation becomes habitual absenteeism (Du Toit amp Van Der Waldt 199818) The
Gauteng Department of Healthrsquos core function is to provide health care services to the
people of Gauteng Province The provision of health care services is labour intensive and
requires large numbers of personnel for effective service delivery
The workplace which may be physical or virtual for the public service employees represent
the internal environment of the institution The employer who is represented by the
manager determines the workplace for employees
Rogers and Hertin (1993217) explain the Decision Model Theory as a conscious decision by
the employee to stay away from work or come to work based on which motivation is
stronger at that moment It is not based on the ability to come to work
Serneels et al (2008210) claim that absenteeism is rife in the public sector especially where
employees hold two jobs The actions of public officials in the performance of their duties
should be ethically justified as it impacts on the decisions of people within and without the
institution individually and collectively Tension and job insecurity in the workplace
manifests as absenteeism (Andrews 199733-137)
12
Frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased staff
morale and high cost to health care (Davey amp Cummings 2009312-313) It is suggested that
on average health care workers are likely to be absent from work as a result of illness or
injury rather than other occupations Dagmara (20002) states that absenteeism may be a
benchmark of what is happening in the hospital setting Absenteeism is defined as habitually
not coming to work when scheduled to It is an indicator of psychological medical or social
adjustment to work
Absenteeism is measured by frequency or duration of work-days missed Frequency
measures provide a reasonable index of voluntary absenteeism whereby each incidence or
episode of absence is counted regardless of the duration of absence It is defined as the
number of days absent over a given period of time Other measures used were total days
duration and percentage Duration measures provide an index of involuntary absenteeism
such as time lost index To assess absence duration the total number of days is tallied
regardless of the number of incidents (Davey amp Cummings 2009313) High workload is
identified as one of the factors that affect absenteeism rate among health care workers
(Oi-ling 20023)
Workplace absenteeism is costly for an institution in terms of lost working-man days hiring
of staff to close the shortage absent or sub-standard service delivery and poor quality of
services The total cost of employment risk approach is about the estimation of the possible
cost of any absent employee to an institution per hour The annual cost to the institutions
per employee is in terms of direct and indirect costs such as overtime low productivity and
a decline in morale among workers who are expected to cover for an absent employee
(Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
The public service employees enjoy security of tenure which may be a contributory factor
of absence from work without good cause This practice is fostered by the knowledge that
they cannot be easily dismissed from their jobs therefore have the belief it is right to stay
away from work Misuse of sick leave is considered to be an overriding problem in instances
where the employee does not uphold the standard of honesty and incorruptibility or these
values are not considered to be the corporate values and norms of the institution (Andrews
1997 221-222 MINTRAC 20093)
Bangali (20043-5) describes age function in the sociological theory as a natural
characteristic of human beings but also an integral aspect belonging to the structure of the
society The age definition in the labour market is influenced by the structural functionalism
The employees age is categorised in the workplace in terms of functions to be performed
be it physical or intellectual The age group of 35 years to 49 years old employees comprise
the largest age group in the labour market
13
The employees who are less than 20 years of age reflect the highest absenteeism rate while
employees above 50 years of age reflect a decrease in the absenteeism rate The
disadvantage of the older workers is that their disabilities last longer once they are injured
and are more likely to be absent as frequently and more likely to be injured than younger
workers Keese (20062) states that ageism is evident in the public service and describes the
age group 25 years to 49 years old as prime age Rogers and Hertin (1993219) found a
significant correlation between the use of sick leave and age Employees with advanced age
used comparatively more sick leave in comparison with the younger employees The
Canadian Nurses Association (20065) noted a reduction in workplace absenteeism rate
among nurses who are less than 45 years of age and an increase in the absenteeism rate
among nurses above 55 years of age
Camp and Lambert (20054) found that the use of sick leave retention as an incentive to
reduce use of sick leave by the employees under the Civil Service Retirement System (CSRS)
leads to a reduction of absenteeism as a result of sick leave compared to the Federal
Employees Retirement System (FERS) who within the same company lost the unused sick
leave when they retired The Employees Retirement System (FERS) applies the same
principle of handling sick leave as the Gauteng Department of Health in the sense that
unused sick leave is forfeited at the end of the three year cycle (DPSA 2009Section 14)
Unruh and Strickland (2007674) found that absenteeism from the workplace does
contribute to a vicious cycle of a negative work environment which leads to more
absenteeism and increased turnover Absenteeism has been found to be higher in
employees who are over 50 years of age and the phenomenon is attributed to age and
changing abilities that increase when work is performed on a full time basis Part-time
arrangements reduce absenteeism as well as the cost of paying for a senior employee even
if seniority is just in tenure Age has been linked to a negative turnover in an institution The
older employee is less likely to leave the organisation An institution is healthier for a spread
of ages Some organisations consider employees to be older in batches or cohorts of five
such as 40 years to 44 years up to 64 years (Nichols amp Evangelisti 2001285 McGoldrick amp
Arrowsmith 200184 MINTRAC 20093 Reday-Mulvey 200579-194)
MINTRAC (20094-8) states that gender moderates the age turnover relationship Women
are more likely to remain in their jobs the older they get than men do Turnover is
occasionally related or preceded by high workplace absenteeism The occupational category
is linked to skill levels and salary levels The lower skill employees are concentrated in the
lower skill occupations and easily replaceable
14
Hirschfield Schmitt and Bedeian (2002553) conducted a research on low-wage public
sector clerical employees and found that those employees who perceived limited
performance-reward expectancies were likely to be absent more often The link between
skilled employees and absenteeism suggested that employees may have utilised
absenteeism as a means of compensating for perceived workplace contributions not
extrinsically rewarded
According to Gaudine and Gregory (2010599) the Canadian Institute for Health Information
(2007) found that absenteeism was a problem among health care workers in comparison to
other employees in other sectors Unruh et al (2007673) found the combination of high
registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery Markussen et al (200921) claim that the type of occupation an
employee is engaged in has an impact on absenteeism
221 Classification of absenteeism
The employees of the Gauteng province and their attendance at work are the focal point of
the province in relation to service delivery that is customer focused Health care services are
labour intensive and require employees to be at work when scheduled to do so (Gauteng
Province 201015) Workplace absenteeism can present in different forms and levels as a
result of a combination of variables (Andrews 19975 Breetzke 20091) McCormick and
Ilgen (198557) and Davey and Cummings (2009313) classify absenteeism as voluntary
when the absence is based on the conscious decision by the health care giver to withhold
contractual services The absence is uncertified unauthorised and unexcused while
involuntary absenteeism occurs for reasons beyond the control of the health care giver
such as illness injury or family responsibility Employers are challenged with the task of
differentiating between the absence due to elective workplace absence and absence due to
illness incapacity The differentiation is based on whether the illness incapacity is validated
by a legitimate medical certificate in terms of the prescript of section 23 of the Basic
Conditions of Employment Act (BCEA) 75 of 1997 (RSA 1997)
222 Definition of key concepts
Concepts are defined for common understanding in the context of the study
Workplace absenteeism Workplace absenteeism is absence of the employee at the
workplace that is defined by Du Toit and Van Der Waldt (1998139) as the place that the
institution makes available and where officials have to perform their work It forms part of
the internal environment for public administration in the public service Bamford Klein and
Engelbrecht (199911) refer to absenteeism as employees taking time off that has not been
scheduled
15
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) claim that
absenteeism is non-attendance when an employee is scheduled to work The European
Foundation (199711) views absenteeism as temporary or permanent incapacity for work as
a result of sickness or infirmity According to Robbins Odendaal amp Roodt (200415)
absenteeism is a failure of an employee to report for work as scheduled regardless of the
reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work The employee
should actually intimate expressly or by implication the intention not to return to work
According to Venter (2003267) desertion occurs when the employee leaves the place of
employment without the intention to return to work
Employee The Basic Conditions of Employment Act no 75 of 1997 Section 1 (a) (RSA 1997)
and Todd (20011) refers to an employee as any person excluding an independent
contractor who works for another person and is entitled to be paid for it or who in any
manner assists in carrying on or conduct the business of the employer The courts use the
control test which identified employees on the basis that they were part of the employer
organisation Bendix (2000123) claims that an employee is a person in a workplace except a
senior managerial employee whose status and contract of service grants the employee the
authority to represent the employer in interactions with the workplace forum to determine
policy on behalf of the employer and make decisions which might conflict with
representation of employees at the workplace Du Toit Bosch Woolfrey Godfrey Rossouw
Christie Cooper Giles and Bosch (200368) state that an employee is a person who works
for a single employer in a permanent fulltime capacity is subject to the supervision of the
employer and receives regular monthly or weekly remuneration and is obliged during
working hours to place his or her productive capacity at the employerrsquos prescribed disposal
Employer
Bendix (2000129) defines an employer as any person except an independent contractor
working for another person or the State and who receives remuneration or any manner
assists in carrying out or conducting the business of an employer DPSA (PILIR) (20094)
states that an employer is the Head of Department or a designated office which will be
responsible for the handling and investigation of incapacity leave applications and ill- health
retirement applications
16
23 EMPLOYMENT RELATIONSHIPS
The employment relationship is about balancing the simultaneous convergent and divergent
interests of the employer and the employee in a regulated manner with the aim of getting
the work of the institution done According to Erasmus et al (2005442) an employment
relationship exists when an individual is employed by someone else to be available to work
for that person in exchange for some remuneration It is through this employment
relationship that reciprocal rights and obligations are created between the employer and
the employee The employment relationship is conflictual in nature (Andrews 199736) The
employees through this relationship are enabled to gain access to the rights and benefits
associated with their employment The Labour Relations Act no 66 of 1995 (RSA 1995)
regulates the management of the conflict in the employment relationship through dispute
resolution structures such as the Commission for Conciliation Mediation and Arbitration
(CCMA) Labour Court and Labour Appeal Court when internal processes fail to resolve the
conflict The employment relationship can be traditional or typical and terms and conditions
of service of employment are regulated by collective agreements This is a tacit
acknowledgement of the existence of a typical employment relation
231 Employment relationship as a multi-dimensional phenomenon
Industrial relations and human resource management are bound together by the
employment relationship through labour employer and industrial relation triangle The
employment relationship is characterised by various dimensions as is the case in a broader
society The dimensions are economic legal individual collective and psycho-social (Grogan
200347)
2311 Economic dimensions
The economic dimension arises through the provision of labour by the employee in the form
of skill knowledge energy abilities and productive time to the employer in exchange for
remuneration Barker (200779) states that a reduction in working hours increases the
hourly cost of production in a unit unless there is a commensurate increase in productivity
The economic dimension is highly regulated The contract of employment includes insured
benefits such as incapacity ill health and early retirement The tendering of services by the
employees is a prerequisite to the employeersquos right to claim remuneration (Grogan
200347) According to LexisNexis (2007176) and the Public Service Regulations 2001
Section E E1 the actual contractual benefits are modified by collective agreements in the
public service sector Employee benefits are material gains for employees that have
monetary value and are a cost factor to the employer The Public Service Regulation 2001
Section F (a) states that the Head of Department shall promote economic and efficient use
of resource to improve the functioning of the public service (RSA 2001)
17
According to Ferguson et al (200137) and Erasmus et al (2005380) employee benefits are
the total compensation package other than the pay for time worked offered to employees
either partially or completely funded by the employer contributions In 2006 about R19
billion was lost on account of absenteeism from sick leave (LexisNexis 2006670 Patrick
2001 17)
Employee benefits are intended to attract retain and motivate employees Some of the
benefits offered to employees are mandated by law such as minimum leave provision as
contained in the Basic Conditions of Employment Act 75 of 1997 and Resolution 72000 of
the Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
2312 Legal dimension
The Labour Relations Act 66 of 1995 Section 3 of Schedule 8 requires that while employees
should be protected from arbitrary action employers are entitled to satisfactory conduct
and work performance from their employees The legal framework provides for the
regulatory requirements for human resource management in the working environment
Grogan (200347) and Grogan (2005120) view the employment relationship as formalised
by a legally binding agreement which is the contract The contract is regulated by specific
laws and formal rules with all the inherent rights and responsibilities to the employer and
the employee In terms of the employment contract one of the responsibilities of the
employee is to render service to the employer at specified agreed upon time except where
the employer has authorised the absence of the employee from the workplace Employees
have a fundamental duty to render services and the employer has a right to expect the
employees to tender such services A basic element of the duty to render service is that the
employee must be at the workplace at the specified agreed upon times unless there is
adequate reason to be absent Bendix (2000120) states that a contract is subject to the
terms and conditions of collective agreements The contract is subject to automatic changes
whenever a new collective agreement is in place The contract and its inherent benefits are
breached by elective absence behaviour of the employee The legal dimension has an
impact on the individual dimension
2313 Individual dimension
The employee enters into a working contract with the employer on an individual basis The
contents of the contract are subject to the Basic Conditions of the Employment Act 75 of
1997 The terms and conditions of employment in the public service are subject to collective
bargaining and collective agreements which influence the employment contract in the
Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
18
The contract of employment is entered into between the employer and the employee under
the supervision of the employer and for remuneration purposes
2314 Collective dimension
According to Slabbert and Swanepoel (20017) the collective dimension of the employment
relationship refers to the organised group aspect of the employment relationship which is
between labour as a group and employers and or their representative public sector
institutions The collective dimension aspect of employment relationship pertains to
legislation relating to bargaining dispute resolution and industrial action
2315 Psycho-social dimension
The psycho-social dimension of the employment relationship represents the unexpressed
needs and expectations of the employer and employees It refers to behaviour in the public
sector institutions within the context of the collective dimension (Davey amp Cumming 2009
313 Erasmus et al (2005442) The Public Service Regulation 2001 Section B states that the
Head of Department shall determine the working time of employees and take into
consideration their personal circumstances which have a social dimension (RSA 2001)
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM
Davey and Cummings (2009322) amalgamated two theories to create a theoretical
framework with the premise that employee attendance is based on two factors the ability
to attend and motivation to attend The theoretical framework focuses on individual work
ethics demographics and from the work environment Some form of absenteeism may be
difficult to prove in a situation where the employer has two or more operational stations or
the employee occasionally operates from a virtual office The duty to render service is
breached by the employee when the employee is physically present and mentally absent as
would be the case of sleeping on duty Workplace absenteeism is multi-dimensional such as
changes in the work environment that overburden the coping mechanism As a result of this
approach a multi-dimensional framework of absenteeism clouds the causative factors of
absenteeism (Breetzke 20091 Patrick 200124 Tustin 199452)
19
FIGURE 21 CONCEPTUAL FRAMEWORK MODEL
(Adapted from Davey amp Cummings 2009320)
The conceptual model uses individual predictors of absenteeism such as age salary level
tenure race gender occupation educational level job satisfaction and organisational
commitment ability to attend and pressure to attend Organisational commitment is
described as having loyalty to the organisation identifying with its core values and
influences whether or not an employee feels it is appropriate to take unauthorised
unscheduled absences Group level absenteeism is not viewed as a predictor of individual
absenteeism (Davey amp Cummings 2009320 Lambert Camp Edward amp Saylor 20058-9)
25 PREDICTORS OF ABSENTEEISM
Oi-ling (20023-6) claims that in Hong Kong there were 47500 work days lost as a result of
employee sick leave in 1998 and suggests the examining of stress levels for nurses in
different cultures to enable a fuller understanding of the predictors of absenteeism as
different cultures accept some predictors and some reject the same reasons for illness
20
Personal characteristics
2Employee value Job
expectation
1Job situation scopejob level role
stress work amp group size leadership
style
4 Satisfaction
with job situation
3 Ability to attend Illness and accidents transport problems
6 Attendance motivation
7 Employee
attendance
5 Pressure to attend work
incentiveswork ethics
Education
salary
tenure age
gender race
Occupation
Lambert et al (20058) claim that organisational commitment job satisfaction job stress
health issues and personal characteristics correlate as regards employee absenteeism The
findings of the research by Van Der Westhuizen (2006136) focused on high and low
combination of job involvement and organisational commitment and the outcome was
emphatic on the turnover as predictor of absenteeism
According to Unruh and Strickland (2007674) absenteeism from the workplace contributes
to a vicious cycle of a negative work environment which leads to more absenteeism and
increased turnover McCormick and Ilgen (198556) describe turnover as dysfunctional
where an employee wishes to leave the institution and the employer prefers to retain the
individual and is functional where the employee wishes to leave the institution and the
employer accepts the termination of services by the employee
De Wit (2006) focused on attitudes towards job factors that had an influence on
absenteeism and was not able to find a high coefficient in the test sample McGoldrick and
Arrowsmith (20018) claim that an organisation is healthier for a spread of ages Ferguson et
al (200138) state that aging employees expose organisations to high levels of absenteeism
through higher probabilities of becoming disabled for longer periods
Oi-ling (20023-6) and Patrick (200124) found that gender and age among other predictors
of absenteeism have a significant influence on absenteeism Age was positively related to
well-being in managers and negatively related to absence frequency among hospital
employees Older employees were shown to have higher responsibility at work and utilised
minimal days for sick leave Female employees were observed to have utilised more
absences than males
Andrews (1997221-222) and MINTRAC (20093-8) state that gender moderates the age
turnover relationship Women are more likely to remain in their jobs the older they get than
men do Turnover is occasionally related or preceded by high workplace absenteeism The
occupational category is linked to skill levels and salary levels The lower skill employees are
concentrated in the lower skill occupations and easily replaceable Public service employees
enjoy security of tenure which maybe a contributory cause of absence from work without
good cause a practice that is encouraged by the knowledge that they cannot be easily
dismissed from their jobs therefore have the belief it is right to stay away from work
Rogers and Hertin (1993217-222) found a correlation between the use of sick leave and
age Employees with advanced age comparatively used more sick leave in comparison with
younger employees The level of education seems to have influenced the use of sick leave
where the lower level categories of employees were found to have a higher level of
absenteeism than higher educated individuals
21
Robbins et al (200447) state that married women employees have fewer absences and
undergo fewer job turnovers Rogers and Hertin (1993222) express tenure as work
experience in years that is viewed as a predictor of employee productivity where seniority
has been found to be inversely related to absenteeism in terms of frequency and total
number of work-man days lost The level of education was found to have an influence
where the lower category of employees was found to have higher levels of absenteeism
than higher educated employees Jacobs and Roodt (2011425) and Davey and Cummings
(2009320) state that an organisational culture in hospitals can contribute towards lower
turnover as the turnover rate is a predictor of absenteeism The process can be facilitated
by promoting knowledge sharing that can provide opportunities that may meet employee
expectations
Pousette and Hanse (2002229-231) suggest that theories that make predictions about
antecedents to ill health and sickness absence make the assumption that the relationships
are the same in different occupations Reduced job autonomy is suggested to be associated
with higher sickness absence The occupation specific model is used in order to identify the
variance in the patterns in terms of occupation-groups Davey and Cummings (2009320)
found that turnover was significantly related to absenteeism
Hirschfield et al (2002553) conducted a research on low-wage public sector clerical
employees and found that those employees who perceived limited performance-reward
expectancies were likely to be absent more often The link between skilled employees and
absenteeism suggested that employees may have utilised absenteeism as a means of
compensating for perceived workplace contributions not extrinsically rewarded Unruh et al
(2007674) found that absenteeism from the workplace does contribute to a vicious cycle of
a negative work environment which leads to more absenteeism and increased turnover
26 A MULTI-GROUP INVARIANCE MODEL
A multi-group invariance structural model represents different types of occupations such as
industrial blue-collar workers industrial collar workers elderly care workers and child
health care workers The focus of this model relates to the extent to which a model that is
assumed to include a general population also includes sub-populations such as different
occupational types The occupation specific model allows different relationships between
variables in different occupations The specific model approach allows for identification of
the most common reasons for absenteeism and early retirement in the workplace and was
successfully utilised in Sweden A common model proposes that absenteeism is a
behavioural response to dissatisfaction with the job (Pousette amp Hanse 2002230-244)
Nyathi (200059) found that professional nurses were absent from work because they
wanted to prolong their weekends
22
Davey and Cummings (2009313) argue that on average health care employees are more
likely to be absent from work as a result of illness or injury than other occupations Paton
(20104) acknowledges that line managers are the fundamental building blocks for reducing
absenteeism and must be provided with the tools to manage absence The absence rate at
3 is considered very high and must be vigorously and progressively managed
FIGURE 22 MODEL SPECIFICATION
(Adapted from Pousette amp Hanse 2002232)
Pousette and Hanse (2002232-245) make the assumption that low job autonomy and low
skill discretion deprive the employees of the opportunity to handle work obstacles and
regulate workload to a manageable level implying a negative relationship to workload has
an impact on absenteeism rate Patrick (200123-24) states that changes in the working
conditions overburden the coping mechanism Work-related stress can lead to deteriorating
physical and emotional well-being The work object is the distinguishing quality between
occupations in the different occupational groups whereby the blue-collar employee works
with things that are tangible such as materials and machines whereas the white-collar
employee is knowledge based employee who is working with data
23
Structural Model
W L Work load
I H Ill-Health
S A Sickness absenteeism
S D Skills discretion
(autonomy)
27 CATASTROPHIC MODEL (CAT)
According to Buschak Craven and Ledman (199628) the catastrophic model (CAT) caters for
major illness that keeps the employee away from work for extended periods of time This
model is similar to short and long term incapacity sick leave whereby the employee has
exhausted the normal sick leave of 36 days which is catered for by DPSA section 14 (RSA
2009)
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM
The general behaviour and actions of public officials are determined by specific ethical
codes of conduct and the unethical conduct results in effective administration and
unsatisfactory service delivery (Andrews 199733) Effective control of workplace
absenteeism requires an absenteeism policy to be in place management to establish the
magnitude and patterns of absenteeism and raise awareness about the consequences of
breaking these rules (Bamford Klein amp Engelbrecht 19992)
The Determination on Leave of Absence in the Public Service (DPSA 2009 section 14 141)
the Public Service Co-ordinating Bargaining Council Resolution (PSCBC 72000) Davey and
Cummings (2009313) and DPSA (PILIR) 2009 section 3 31 state that an employee is
entitled to 36 working days sick leave with full pay in a three year cycle with the same
employer Any unused leave credits shall lapse at the end of the three year cycle The
employee is expected to utilise and manage the normal leave circumspectly The employee
who chooses to utilise sick leave days must submit a medical certificate for every occasion
of three or more sick leave days utilised The medical certificate must be issued and signed
by a practitioner or persons who are registered with the Professional Councils established
by the Act of Parliament Incapacity leave is additional sick leave granted conditionally at the
employerrsquos discretion An employee who has exhausted the normal sick leave during the
prescribed sick leave cycle and who requires to be absent from work due to a temporary
incapacity may apply for temporary incapacity leave with full pay According to the Policy
and Procedures on Incapacity Leave for Ill-Health Retirement (PILIR) (DPSA 2009) an
employer is not required to pay an employee if the employee has been absent from work
for more than two consecutive days or more than two occasions during an eight week
period and on request does not produce a medical certificate
The Public Service Regulations 2001 F (c) holds the manager accountable when an
employee abuses sick leave (RSA 2001) According to Parbhoo (20036) and Nel et al
(2008145) the doctor patient confidentiality is not above reach to the employment
relationship by suggesting that the employer can question the authenticity or contents of
the medical certificate if there is sufficient reason to do so within the confines of
confidentiality
24
According to Breetzke (20092) South African employees are challenged by global trends to
seek mechanisms to deal with excessive absenteeism at the workplace The Charted
Institute of Personnel and Development (CIPD) (200811) claims that the 2006 survey
showed that public sector employees are less likely to be disciplined or dismissed for
reasons of workplace absenteeism
281 Measuring absenteeism
Measuring absenteeism in the workplace enables the employer to determine the extent and
nature of the problem Absenteeism is measured using two measures total time lost and
absence frequency Nel et al (2001584) In institutions total time lost is determined for
every group of employees and category of absence such as sick absence authorised and
unauthorised absence The recognised international norm is 3 Institutions challenged
whether to accept the international norm as the given or strive to bring workplace
absenteeism down in the interest of quality and quantity of service delivery The total time
lost index is calculated as the Total number of days lost due to absence over the period
multiplied by a thousand and divided by the average number of employees multiplied by a
thousand and divided by an average number of employees multiplied by total work-days
over the period (Amin Das amp Goldstein 20086 Breetzke 20094 Nel et al (2001584)
According to Nel et al (2001584) high workplace absenteeism rate is suggestive of incidence
that is of short duration and therefore more disruptive to the operational plans of an
institution as prior knowledge of pending workplace absenteeism allows for forward
planning and reduction of the costs associated with absenteeism The absence frequency
rate is calculated as Number of absence incidence over the period divided by the average
number of employees employed over the period (Breetzke 20094 Nel et al 2001254)
29 IMPACT OF WORKPLACE ABSENTEEISM
Lambert et al (20056 36) claim that absenteeism has adverse effects on those employees
who are good attenders as they are shuffled around to fill in the positions of absent
employees Organisations suffer the detrimental effects and consequences of employee
absenteeism Management expend valuable time to modify employee assignments to
respond to absences When employees who are in management or in highly specialised job
assignments report sick the work assigned to them remains undone because their positions
remain vacated and the work remains for them to complete The responsibility and
accountability these employees are entrusted with may influence less use of sick leave by
them
The White Paper on Transforming Public Service Delivery (DPSA 1997) holds management
responsible for the specific level of resources and for obtaining value for money in these
resources
25
Madibana (201022) found in the research about absenteeism amongst nurses that the high
rate of absence had an impact in the reduction of quality care rendered by nurses
291 Cost to the institution
Andrews (19978221) describes an institution as the process through which activities are
grouped logically into the distinct areas and assigned to managers It results in the logical
grouping of activities in a department Workplace absenteeism influences the cost of an
institution which influences the quality of the product or service that is rendered by the
institution Employee attendance is a vital element for managing productivity of any
institution and its individual members The unfilled posts reflect the absence of public
health care employees and do not absorb budget resources for salary and upkeep of
facilities Absent personnel still receive their salaries If public servants are not on the job
the expenditures embodied in them do not reach their beneficiaries (Chaudhury amp Hammer
20032 Lambert et al 20055) The cost is direct in terms of salary expenditure or indirect in
terms of staff replacement
Ferguson et al (200138) argue that the cost of employment risk approach is about
estimation of the possible cost of any absent employee to an institution per hour per day
Robbins Odendaal and Roodt (200415) estimate that absenteeism costs South African
institutions millions of rand a year in decreased efficiency and increased benefit payments
Fakie (20053) notes that sick leave costs the national government 15 of the total basic
salary expenditure for the National Department of Health from 1 January 2001 to December
31 2003
The South African Chamber of Business (SACOB) (Patrick 200117) acknowledges that in
2006 about R19 billion were lost on account of absenteeism resulting from sick leave
According to the European Foundation (19977) United Kingdom lost 11 billion pounds in
1994 Germany lost 30 5 billion EUC in 1993 and Belgium lost 24 billion EUC in 1995
Breetzke (20092) describes indirect costs as hidden costs harder to measure and may
include economic value of lost productivity Indirect costs relate to loss of production that
may arise by engaging some expects to provide service in the field where they are closing
the staff shortage gap Rogers and Hertin (19939) and the European Foundation (19978)
view the individual employee and his or her dependants in a social dimension aspect as
exposed to reduced income as a result of extended workplace absenteeism related to ill
health where long term incapacity is involved
The total cost of employment risk approach is about estimation of the possible cost of any
absent employee to an institution per hour The cost may be direct and indirect such as
overtime low productivity and a decline in morale among workers who are expected to
cover for an absent employee (Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
26
292 Low productivity
According to Jankowitz (19911) high levels of absenteeism are disruptive to production
where operators are interdependent or where levels of service have to be maintained
Buschak Craven and Ledman (199626) argue that absenteeism generates costs for the
institution and productivity problems put an unreasonable burden on the rest of the
employees who are at work An absent employee be it physical or psychological remains an
unproductive employee Absenteeism viewed from an employerrsquos perspective is regarded as
a problem that impacts negatively on service delivery while the employeesrsquo believe their
mere presence in the workplace is being productive
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM
Managing workplace absenteeism remains a challenge for all employers and the Gauteng
Department of Health has not been spared the challenges faced by other institutions as it
provides health care services to the citizens of Gauteng The provision of good quality health
care is vital for the development of human capital The implications of declining quantity
and quality of care is grave when the human capital equity and efficiency which are the
cornerstones of health care service delivery are threatened by employees who are not at
work when expected to be (Gauteng Province 200711) Misuse of sick leave is considered to
be an overriding problem in instances where the employee does not uphold the standard of
honesty and incorruptibility or these values are not considered to be the corporate values of
the institution (Andrews 1997 221-222 MINTRAC 20093)
According to Grogan (2005237) employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
identify trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
Part V Section F(c) (RSA 2001) The workplace can be a virtual office Workplace
absenteeism is perceived to be high in unionised workplace environments where unions are
perceived to be capable of exerting control over the employer and employee relations for
the primary benefit of the employees In the public sector contractual employee benefits
are modified by collective agreements
Public service managers are to focus towards results achievement and be accountable for
the performance of their institutions (Gauteng Province 201023) Workplace absenteeism
can be reduced by tightening up policies and procedures relating to control of absenteeism
and intensifying monitoring processes on absent employees
27
According to Cloete (2004290-297) public institutions are to provide quality goods and
services The public institutions require an appropriate infrastructure to enable them to
perform their core functions (Bamford et al 19991 Buschak et al 1996 28 Munro
200722)
2101 Effective communication
According to Oi-ling (200212) managers should alter the psycho-social environment at work
and cultivate an institutional climate that supports staff and facilitate effective
communication Institutions should raise awareness to employees of their rights and
responsibilities regarding leave of absence and the consequences of abusing it (Bamford et
al 19992) The policies should be clearly written and well communicated to all employees
and be readily available and accessible In a highly unionised environment these policies are
debated in bilateral or multi-lateral forums between management or employer
representatives and labour representatives The human resource practitioners must conduct
periodic in-house training on these policies for management and employees to facilitate
uniform interpretation and enforce compliance by all stakeholders The policies must be
couched in simple understandable language that is free of legal terms for ease of
comprehension by all users The policies on workplace absenteeism must be explicit of
actions to be taken when policies have been violated or employees are aggrieved
2102 Empowerment of managers
Workplace absenteeism is multi-dimensional requiring inputs from all related fields
Managers require on-going support and training on issues that relate to absenteeism at the
workplace The human resource unit works with managers to establish performance
standards training of employees on the importance of execution and assists managers to
focus on continuous improvements superior execution and employee empowerment
(Bergdahl 20019 RSA 2011)
The labour relations unit supports the training of managers on grievance handling bilateral
and multi-lateral encounters with employee representatives with employee education
issues specific to workplace absenteeism The Charted Institute of Personnel and
Development (CIPD) (200835) reported that 70 of managers in the public service have
been trained in workplace absenteeism handling
Employment relationships bind human resource and industrial relations together with the
common objective of achieving institutional goals and labour peace Managers focus on
managing the institution for productivity at the lowest possible cost by providing quality
care therefore reducing the risk of litigation control of absence from work and work
efficiency
28
It is the delays in dealing with issues that give the employees the feeling of being unfairly
treated and demoralised Consistency in upholding these processes is essential for creation
of a stable employment relationship while any deviation from the set processes give rise to
worker unfriendly environment (Bergdahl 20118-9)
2103 Monitoring of workplace absenteeism
The manager is expected to keep accurate records for all leave of absence taken by
employees In terms of the management of ill-health absencersquos the manager has to ensure
that the eight week rule is observed whereby the employee who has been absent from
work on more than two occasions during an eight- week period must regardless of the
duration of the sickness or injury submit a medical certificate (RSA Part V section F (b)
DPSA 2009 section 14 148) Pierce (200921) believes that management of human capital
may be achieved through the integration of employee benefits employee assistance
programmes and human capital
Monitoring of absenteeism is a human resource function that gets lost in the competing
functions that are carried out by human resource practitioners High levels of absenteeism
are an indication of poor management and or conflict within the employment relationship
The methods to monitor workplace absenteeism vary from one institution to the other It is
human resource management that establishes common guidelines that are used by
management to monitor workplace absenteeism In monitoring absenteeism the manager
considers each employeersquos case on its merit
The manager focuses on certain aspects of the case such as failure to call in on the day of
absence pattern of use of sick leave before or after holidays and sick absence occurring on
certain days of the week or month Monitoring systems to monitor and record attendance
of work are put in place to assist management with simple accurate functional data that
facilitates informed decision- taking at management level The employees of the province
and their attendance at work become the focal point of the province in relation to service
delivery Peer pressure monitoring comes from colleagues at the same facility Hierarchical
monitoring of employees by management may lead to more attendance for fear of being
discovered (Chaudhury amp Hammer 200319 Gauteng Province 201015) A health care
service institution may use Health Information System and Personnel and Salary
Administration System (PERSAL) among others to ease the burden of the monitoring
process All these tools combined are useful in gathering administrative data for
management
29
2104 Visits to facilities
The role of human resource at institutional level is to support and guide management as
well as monitor compliance issues Workplace absenteeism remains a key focus area
because of its impact on the budget of an organisation Unscheduled facility visits are
conducted with the view to audit workplace absenteeism The audit is to be done in line
with the auditor-general or internal risk managementrsquos approach to encourage consistency
A check list that is used is prepared by human resource practitioners and institutions are
familiar with A human resource accounting officer of the institution should be involved
when an audit is done
The institution must have evidence available of sporadic visits to employees who have been
identified as having developed absenteeism patterns with the view to rule out elective
absence The European Foundation (199713) and Munro (200722) state that ill- health is
the main reason for workplace absenteeism Employees who present with ill- health are
generally and frequently more absent from work than the healthy ones The authors also
observe that not all employee assistance programmes aimed at reducing workplace
absenteeism have an effect on the ill-health of the employees which render the
unscheduled visit to the employees vital to see where the caring employer could be of
assistance
2105 Incentive system
According to Buschak et al (199628) the catastrophic model (CAT) caters for major illness
that keeps the employee away from work for extended periods of time This model is similar
to short and long term incapacity sick leave which is catered for by PILIR subsection 73
(DPSA 2009) The managers require special training for successful implementation of the
policy The paid time off model (PTO) has hidden benefits incentives for employees not to
use unnecessary sick days which are then paid for at retirement The research by Lambert
and Camp (20054) compares the Civil Service Retirement System (CSRS) and the Federal
Employees Retirement System (FERS) and showed that in the final analysis and when
novelty wore off workplace absenteeism was not necessarily reduced by the incentive
system
Management should use the strategy to raise awareness about responsible utilisation of sick
leave through workshops about PILIR and the eight week rule It should show the benefits
of good sick leave management when employees are challenged with temporary or
permanent incapacity leave
The use it or lose it approach of the current system reward the abuse of sick leave as it is
viewed as not being beneficial by the employees to act responsible towards the use of sick
leave There is no deterrent not to abuse sick leave in the public sector
30
2106 Team support
Institutions value team effort over individual achievement Operational competencies are
viewed as essential Managers encourage effective communication among team members
motivating others and the development of problem-solving skills Managers through the
team development effort encourage nurturing and transmitting of the institutional culture
Institutional culture refers to a system of shared meaning within an organisation that
determines how employees behave in the workplace Culture and people are like glue that
ensures that institutional standards are upheld Individuals become units that form the
team and conversations at work are encouraged to strengthen team work knowledge
transfer and productivity (Bergdahl 20018-10 Goldsmith amp Morgan 200378 Robbins amp
Decenzo 2001174)
2107 Return-to-work interviews
According to Paton (20101ndash5) a phased return-to-work data management and remote
services are among the approaches employers may use to manage workplace absenteeism
The intervention can involve use of Information Technology systems and telephone
discussions Good absence management is about good people management The return-to-
work interviews provide management with the opportunity to get to know the employee
better and for the employee to substantiate his or her case The employee is afforded
privacy during the sessions which should happen as soon as the employee comes back to
work The key success in this strategy is unthreatening follow ups that are done A multi-
faceted approach is used to get people back to work such as phoning maintaining regular
contact and taking medical advice
The Charted Institute of Personnel Development Annual Report (200835) reported 90 of
public services that use the strategy and 77 use the risk assessment to aid return- to-
work The manager should have private counselling sessions with the employee as soon as
the employee returns to work These sessions provide the employee with the opportunity to
put his or her case across and for the employer to get a first-hand opportunity to asses if the
employee is fit enough to come back to work The employer has to make the employee
aware of the status of the meeting that it is formal and proceedings are recorded The
employer is to keep accurate records of all counselling sessions
31
2108 Employee assistance programme (EAP)
DPSA (PILIR2009) prescribes that the PILIR committee promotes EAP in the workplace and
each institution to establish a committee The PILIR committee consists of a labour relations
officer an EAP practitioner a health practitioner an employee wellness practitioner and
any other relevant practitioner who is co-opted on a needs basis The purpose of the
committee is to manage short and long term incapacity which is sick leave utilised after the
employee has exhausted the 36 days normal sick leave in a three year cycle The short term
incapacity sick leave is of longer than three days and less than 29 days and long term
incapacity is sick leave longer than 29 days The short spells of sick leave become a concern
when there is evidence of a pattern of abuse It is a call for the manager to intervene Every
organisation should provide EAP that is funded by the employer to the employees A health
risk manager is used by the employees who are expected to honour referrals and stay with
the programme until such time that there is evidence of recovery failure by the employee
to accept the programme should attract a disciplinary process
According to Mellor Arnold and Gelade (20098) the amount of support that followers
receive from their transformational leader or co-worker may help reduce levels of absence
by making the workplace a more pleasant place to be and perhaps by helping the person
find solutions to work out family conflict or other problems that produce absence Landstad
et al (20011) suggest that the individuals in the preventive intervention group who were
less than 42 years of age total absence due to sickness decreased The change was obvious
to the cleaners who had a previous history of high absence due to sickness The Charted
Institute of Personnel Development (200836) focused on working-man days lost
management of absenteeism employee well-being and employee rehabilitation The skilled
employees were reported as 12 who were using rehabilitation programmes Yende
(200535) and Fakie (200517) state that EAP despite having been around since 1996 for the
National Department of Health has not actually been managed and utilised to its full extent
whereby if fully utilised would assist in the management of employee workplace
absenteeism
2109 Occupational and safety committee
The focus of this committee is on the provision of a safe working environment by the
employer (RSA Part VI section D 2001) It monitors issues of compliance and adopts the
employee advocacy role The committee consists of all the major stakeholders such as
employee representatives labour representatives that represent employees in the
institution on issues of safety at the workplace In the context of the Gauteng Department
of Health the committee engages with the labour representatives and employer
representatives at bilateral and provincial multi-lateral scheduled meetings
32
According to Du Toit and Van Der Waldt (1998139) the International Labour Organisation
recommends creation and maintaining of a pleasant work environment in order to improve
productivity The environment must stimulate the employee to ensure efficiency and
effectiveness
21010 Review committee
This structure is essential when dealing with incapacity leave It is composed of
management human resource practitioner employee representative labour relations
officer employee wellness and any adhoc person needed in terms of the case under
discussion (DPSA PILIR 2009) The employee reserves the right to lodge a grievance about
the outcome of his incapacity request if it is negative The role of the committee is to
provide a transparent forum reduce hostility against management and to protect the rights
of the employee through involvement of the employee representative
211 CONCLUSION
The literature review that has been consulted explores the workplace absenteeism and its
impact on the institution The employment relationships represent a triangle that consists of
the employer the employee and the industrial environment The relationship is multi-
dimensional and highly regulated with built in mechanisms to handle conflict in the
workplace Conflict is inherent to the employment relationship and structures and
mechanisms such as bargaining councils the Commission for Conciliation Mediation and
Arbitration and Labour Courts are structures for recourse The theory of absenteeism and
employment relationship were explored Management intervention strategies were
explained Controlling absenteeism in the workplace begins with a sound absenteeism
policy that is incorporated into an employee induction programme Communicating and
educating the employees about the absenteeism policy takes the centre stage in the
employment relationship Vigilant monitoring of workplace absenteeism is the responsibility
of the manager closest to the employee such as the supervisor Workplace attendance
problems of employees can be handled using sound judgement keeping accurate
attendance records and administering the policy fairly and consistently
Chapter 3 will collect data which will confirm or negate the literature review that has been
explored in chapter 2
33
CHAPTER 3
METHODOLOGY OF THE RESEARCH
31 INTRODUCTION
Chapter 3 focuses on the methodology used to determine the absenteeism in the four
hospitals of the Gauteng Department of Health The research design and the methodology
that have been used to collect data are discussed below The data are collected in terms of
the characteristics of the stratified random sample such as absenteeism of the different
occupational categories gender age tenure of service race groups and salary
32 RESEARCH DESIGN
A research design is the overall plan for relating the conceptual problem to relevant
empirical research It is a quantitative descriptive research that involves the systematic
collection of numerical information under conditions of considerable control The choice of
the research design influences subsequent research activities such as identifying the target
subjects what data to collect and how they should be collected The research design is a
descriptive survey which is concerned with characteristics of a specific population subject at
a fixed point in time for comparative purposes The focus is on a representative sample of
the relevant population It is concerned with the accuracy of the findings and their
generalisability The survey is used to understand the behaviour of employees with regards
to motivation satisfaction and grievances (Babbie 1992 89 Ghauri et al 199527 60 Brink
199611 Welman et al 200152)
321 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services The four hospitals that have been targeted for the study of absenteeism are Tara
Moross Centre Hospital in Region A under the Johannesburg Metropolitan Municipality
Germiston Regional Hospital which is in Region B under Ekurhuleni Metropolitan
Municipality ODI District Hospital in Region C under Tshwane Metropolitan Municipality
and George Mukhari Academic Hospital in Region C under Tshwane Metropolitan
Municipality Each hospital is unique in its character in terms of specialisation of health care
delivery service The sample is a stratified random sampling which is composed of various
clearly recognisable non-overlapping sub-populations (strata) that differ from one another
in terms of variables that are a combination of more than one variable such as age sex
income level or educational level The purpose is to ensure that every part of the population
(every stratum) is represented The members of a particular stratum are homogeneous with
the population at large
34
The sample is representative of a population with clearly distinguishable strata with a
greater degree of certainty (Babbie 19927 Brink 1996138 Brynard amp Hanekom 2005 44
Ghauri et al 199578 Welman amp Kruger 200155-56 Polit amp Hungler 199518)
The data were collected in three phases The first phase of data collection was done through
auditing of hard copies of identified personnel files encomprising ten files per hospital and
using the tools in annexure A and B The forty employeesrsquo profiles were accessed through
the Human Resource Information System (HRIM) located in the Gauteng Department of
Health Head Office The respective employeesrsquo profiles were handed over to the human
resource manager in the respective hospital on the morning of the audit for the human
resource practitioner to draw out the hard copy files for auditing The characteristics of the
individuals that were identified for the first phase were males and females as well as
representatives from the different race groups The auditing of the files were for the
complete working life of the employees and not only confined to 2008 calendar year
Registers that are used by human resource administration to control the movement of the
leave form were inspected as evidence of the control system in place The purpose of
auditing the files was to gain insight into how leave in general was captured managed and
controlled by the hospitals
The second phase of data collection were done through structured interviews with four
human resource managers who were directly accountable for management and control of
leave of absence in general in the four hospitals A structured interview provides for a more
organised approach and a more stable basis for assessment of the different candidates
(Erasmus et al 2005250) The structured interview was conducted using the tool in
annexure C Tara Moross Centre Hospital had been functioning without a human resource
manager and the manager that was interviewed had been in the post for three months The
human resource practitioner who was at salary level 8 and acting in the Assistant Directorrsquos
post (manager level 9) was invited to join the manager and be part of the structured
interview ODI District Hospital had three human resource practitioners including the
accounting officer at level 8 in an acting capacity The third phase of data collection was
through the Human Resource Information Management System (HRIM) This system uses
the Personnel Remuneration Administration System (PERSAL) to collect data Data in this
system is categorised in characteristics such as salary level date of appointment
occupational category gender age in units of five race employing hospital employment
status in different sub-categories such as session contract and full-time and the different
types of leave of absence The continuous sick leave of four to five days was excluded from
processing and focus was laid on sporadic days to the start and end of a weekend
35
The research used secondary data in analysing sick leave utilised by full time employees in
the identified hospitals for the period of 1 January to 31 December of 2008 using Persal The
total population sample was four thousand and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range from level 1 to
12 The research used past events such as sick leave utilised by employees using secondary
data from Persal falling into the category of historical empirical study The interval scale of
measurement was used in the quantitative research and actual numbers are ordered with
equal measurement between each category (Brink 1996 149 Brynard amp Hanekom 200528-
29 Mouton 200552100170)
33 UNIT OF ANALYSIS
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the study refers to observation of work attendance by the
employees of Gauteng Department of Health in the four hospitals The observation deals
with the historical events as employees have already utilised the sick leave in the workplace
The subjects that are studied are the core health care providers such as doctors nurses and
support employees such as allied administration and administration support (Mouton 2005
51-52 Welman et al 2001 52-53)
34 UNIT OF OBSERVATIONS
The observations that are made are of health care employees and support teams in Tara
Moross Centre Hospital Germiston Hospital ODI Hospital and George Mukhari Hospital
and describe the characteristics of a large number of individual people such as sex age
salary range occupational category tenure of service and race in relation to absenteeism in
the workplace The descriptive study and the individual characteristics are aggregated for
the purpose of describing a larger group (Babbie 199292)
35 CONSTRUCT VALIDITY
Construct validity is concerned with the question What construct is the instrument actually
measuring (Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with four of the accounting officers in the leave managements The third phase was
collecting of personnel data through the Persal system
36
36 ETHICAL CONSIDERATIONS
Ethical considerations will include amongst other issues such as the protection of the units
of analysis and units of observations from discomfort and harm by not revealing
information which can cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity
Anonymity is achieved when the researcher cannot link a given response with a given
respondent and reporting aggregate data only When data are collected at one sitting and
not over a period of time makes it possible to achieve anonymity as the need for follow up is
eliminated Subjects of observations are selected for reasons directly related to the problem
being studied as the principle of justice Confidentiality is about the researcherrsquos
responsibility to protect all data gathered within the scope of the study and shared only
with people involved in the research (Babbie 1992465ndash466 Brink 199640ndash41 45 Polit amp
Hungler 1995 31-36)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous to the researcher The interview was part
of the actual audit that was done as part of monitoring and evaluation that was in progress
in the Department of Health following a negative auditor generalrsquos report about
management of leave in general The managers were put at ease as they were given the
checklist afterwards for self-monitoring and for future self-auditing
The data that were collected through Persal identified employees through the Persal
number and kept their identities anonymous The data that were collected through the hard
copy of employeesrsquo files were used to point out areas of concern to the managers and the
files did not leave the office of the manager at the end of the process once more protecting
the identity of the employee
37 CONCLUSION
This chapter dealt with the research design which is the overall plan for relating the
conceptual problem to relevant empirical research The methodology used a stratified
random sample which is composed of various clearly recognisable non-overlapping sub-
populations that differ from one another in terms of variables that are a combination of
more than one variable The data collection was done through three phases The unit of
analysis refers to the persons who are studied The unit of observations are health care
workers and support teams in the four identified hospitals The construct validity used a
multi-trait multi-method approach Ethical considerations include among other issues
protection of the unit of analysis and the unit of observations from discomfort and harm
Chapter 4 discusses the analysis and interpretation of the data gathered in chapter 3
37
CHAPTER 4
INTERPRETATION AND ANALYSIS OF DATA
41 INTRODUCTION
This chapter focuses on the research analysis and interpretation of data gathered on
workplace absenteeism in the Department of Health of the Gauteng Province It seeks to
identify differences or similarities in the leave trends in the 2008 calendar year between the
four identified hospitals chosen for the study in the Municipality of Tshwane Ekurhuleni and
Johannesburg The year 2008 was chosen as a second year in the leave cycle that started in
2007 The type of leave of absence is interpreted as a collective that does not specify the
type of sickness or illness or it being acute or chronic Workplace absenteeism is absence of
the employee at the workplace that is defined by Du Toit and Van Der Waldt (1998139) as
the place that the institution makes available and where officials have to perform their
work It forms part of the internal environment for public administration in the public
service Direct public administration is directly concerned with the rendering of services to
the citizens of the country
Chapter 4 discusses the study of workplace absenteeism in the four identified institutions
namely Tara Moross Centre Hospital Germiston Hospital ODI District Hospital and George
Mukhari Hospital In this research the following factors will be examined the organisational
structure and absenteeism of the different workforce categories such as medical and
nursing professionals administrative staff allied professionals and various categories of the
general assistants workforce and their relation to absenteeism in the institution
42 THE STRUCTURE OF THE ORGANISATION
The Gauteng Province is one of the nine provinces of South Africa In 2005 the auditor-
general conducted an audit of sick leave performance in six national departments and the
Gauteng Province was among those that were omitted from the audit The research focuses
on the Gauteng Department of Health (GDoH) whose core function is to provide health care
services to the people of Gauteng The provision of health care services is labour intensive
and requires large numbers of personnel for effective service delivery The GDoH is serviced
by thirty-four hospitals four of which have been identified for the study of management of
sick leave The employee attendance to work is essential to the achievements of the
Departmental goals The Determination on Leave of Absence determines the leave policy for
public service employees (DPSA 2009) The employees of GDoH represent the staff
component as reflected in the organisational structure of the department
38
The Gauteng Department of Health (GDoH) provides the basic health services to the people
of Gauteng who as internal or out-patients are clients or consumers of the services referred
to as line functions Public administration services rely heavily on support services such as
the personnel department that renders support to line functions that provide the actual
service of patient care Support services are considered as indirect public administration
services and essential in efficient public service delivery Workplace absenteeism has a
negative impact on productivity Employees of the Gauteng Department of Health and their
attendance to work are the focal point of the Province in terms of effective health care
service delivery that is customer focused
Political ideologies as those espoused by labour representatives are part of the external
factors in the workplace environment that consequently have an impact on public
administration and management and workplace attendance by employees (Du Toit amp Van
Der Waldt 1998139170)
FIGURE 41 INTERGRATED ORGANISATIONAL STRUCTURE
(Adapted from Gauteng Department of Health organisational structure 2010)
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY
The Gauteng Provincial Government has made a commitment to its people to account for
the delivery of services as its electoral mandate This commitment will be achieved only
when monitoring and evaluation of its performance is enforced by all Gauteng Department
of Health service providers
39
MEC
HOD
COP
Senior Exec
CD HAST CD Health program
Senior Exc
CD Tshwane
CD JHBWest
CFO
Manage Account
SENIOR CORPORATE
HRM amp LR
GenderampDisability
The Gauteng Governmentrsquos commitment to provision of health care services to all its
citizens is demonstrated by the decentralisation of management of service delivery with the
view to foster accountability increase efficiency and accountability (ANC 199419ndash20
Goldstein 200815) The interpretation of the analysed data takes the sector performance
approach into consideration when the interpretation of absence is across all the
occupational groups for the 2008 calendar year (Gauteng Province 201015)
44 COMPARISON OF HOSPITALSPERMANENT EMPLOYEES
Gauteng employees are counted at 51475 from the Personnel Salary Administration System
(PERSAL) as of March 2008 The population from the four chosen hospitals has been
counted at 4010 reflecting 8 of the total population The different groups of employees
were identified as Africans represented as n=3902 Whites as n=51 Indians as n=14 and
Coloureds as n=43
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALS
(Source Compiled by the researcher C S Ndhlovu 2012)
Figure 42 reflects the racial split percentage of the workforce (n=4010) of the hospitals
The population from the four hospitals has been counted as 4010 reflecting 8 (n=51475)
of the total working population for Gauteng Department of Health as from 1 January to 31
December 2008 The different groups of employees were identified as Africans represented
by 973 (n=3902) Whites as 13 (n=51) Indians as 03 (n=14) and Coloureds as 11
(n=43) The George Mukhari Hospital has a female dominated workforce at 739 (n= 2097)
in a total workforce of n=2836
40
Population n=4010
Africans 973
Whites 13
Coloureds 11
Indians 03
TABLE 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALS
RACE TARA HOSPITAL GERMISTON GEORGE
MUKHARI
ODI TOTAL
Africans 227 367 2836 472 3902
Whites 23 24 3 1 51
Coloureds 5 37 0 1 43
Indians 13 1 0 0 14
Population 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 1 focuses on the distribution of race and the population of the total workforce The
geographical area of the hospital determines the demographics and the tendency of some
groups being poorly represented or totally absent The research focused on permanent
employees of the four hospitals The George Mukhari Hospital employees are reflected as
7079 (n=2839) ODI Hospital as 1182 (n=474) Germiston Hospital as 1069 (n=429)
and Tara Moross Centre Hospital as 668 (n=268) of the total working population Tara
Moross Centre and Germiston Hospitals are located in cosmopolitan areas while the George
Mukhari and the ODI Hospitals are in rural and semirural areas The positioning of the latter
hospitals may account for the high African workforce
41
TABLE 2 COMPARISONS OF NUMBERS OF ADMINISTRATION AND SUPPORT STAFF IN THE
DIFFERENT HOSPITALS
OCCUPATIONAL
GROUP
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Administration
staff
48 60 297 61 466
Administration
support
103 140 719 133 1095
TOTAL 151 200 1016 194 1561
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 2 presents the administration employees and the administration support in the four
hospitals Tara Moross Centre Hospital is represented by 3179 (n=151) of administration
and 6822 (n=103) administration support The George Mukhari Hospital has the highest
representation by the administration support at 7077 (n=1016) The high representation
of the administration support staff at George Mukhari Hospital could be partly because of
the semi-rural environment A semi-rural environment is usually characterised by poverty
which may have a negative influence on opportunities to access education and skills
Doctors and nurses are highly marketable because of the educational levels and skills that
are lucrative and enable this group to be highly mobile geographically (Chaudhury amp
Hammer 20033)
42
TABLE 3 GENDER COMPARISON IN DIFFERENT HOSPITALS
GROUPS HOSPITALS MALE FEMALE POPULATION
Africans Tara 83 144 227
Germiston 52 315 367
George Mukhari 739 2097 2836
ODI 109 363 472
TOTAL 983 2919 3902
Whites Tara 5 18 23
Germiston 5 19 24
George Mukhari 3 0 3
ODI 1 0 1
TOTAL 14 37 51
Indians Tara 1 12 13
Germiston 0 1 1
George Mukhari 0 0 0
ODI 0 0 0
TOTAL 1 13 14
Coloureds Tara 1 4 5
Germiston 6 31 37
George Mukhari 0 0 0
ODI 1 0 1
TOTAL
GRAND TOTAL
8
1006
35
3004
43
4010
(Source Compiled by C S Ndhlovu 2012)
Table 3 focuses on gender distribution in the population of the research represented by
males and females in the different racial groups
43
The geographical area of the hospital determines the demographics and the tendency of
some groups being poorly represented or totally absent The males of the different hospitals
account for 251 (n=1006) while the females account for 749 (n=3004)
The George Mukhari Hospital has a female dominated workforce at 7394 (n=2097) out of
a total workforce of n=2836 White male employees are represented by 011 (n=3) against
the total workforce of the hospital (n=2839) There are no Indians and nor any Coloured
employees African males are represented by 2603 (n=739) The same hospital has no
white female employees no Indians no Coloureds and 7395 (n=2097) African females
The table reflects a predominantly African female workforce The hospital is situated in a
rural setting and this may have an impact on the vast difference in the gender
representation
The Tara Moross Centre and Germiston Hospitals are located in cosmopolitan areas They
have 187 (n=5) and 1117 (n=5) White male employees respectively and 672 (n=18)
and 443 (n=19) female employees respectively Tara Moross Centre Hospital has 4 48
(n=12) female Indian employees while Germiston Hospital has only 024 (n=1) Germiston
Hospital has 723 (n=31) female Coloured employees while Tara Moross Centre has 150
(n=4) The core function of the various hospitals may have influenced the gender
distribution
TABLE 4 COMPARISON OF TENURE OF SERVICE IN RELATION TO ABSENTEEISM IN THE
FOUR HOSPITALS
TENURE IN YEARS DAYS OF ABSENCE PERCENTAGE
1ndash10 4451 30
11ndash20 6577 443
21ndash30 2934 198
31ndash40 878 59
TOTAL 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 4 reflects the level of tenure of the total workforce from 1 year to 40 years of service
Tenure of 11 years to 20 years of service reflects 443 (n=6577) utilisation of leave of
absence and remains the highest rate of absenteeism followed by tenure of 1 to 10 years of
service at a 30 absenteeism rate
44
TABLE 5 COMPARISON OF THE OCCUPATIONAL GROUPS IN THE DIFFERENT HOSPITALS
OCCUPATIONAL
CATEGORIES
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Doctors 12 12 354 19 397
Professional
nurse
47 81 548 109 785
Staff nurse 15 53 358 56 482
Nurse assistant 16 50 308 55 429
Social worker 4 4 8 3 19
Occupational
therapists
4 0 15 1 20
Radiographer 0 3 27 6 36
Clinical
Psychologists
4 0 10 2 16
Physiotherapists 0 1 9 1 11
Dieticians 0 0 5 3 8
Finance 4 11 59 9 83
Speech
therapists
0 0 5 1 6
Pharmacists 2 9 36 5 52
Dentists 0 0 0 3 3
Technicians 2 5 51 6 64
Librarian 1 0 0 0 1
Security 6 0 30 1 37
Administration
and support
151 200 1016 194 1561
TOTAL 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 5 reflects a great difference in terms of number of occupational groups in the four
hospitals
45
The core function and the size of the hospital seems to have a bearing on how many
occupational categories of employees are to be found in that hospital as well as the actual
figures of these categories The George Mukhari Hospital is an academic hospital that trains
medical doctors This hospital has 1247 (n=354) doctors in a staff establishment of
n=2839 Tara Moross Centre has 448 (n=12) in a staff establishment of n=268 Germiston
has 280 (n=12) in a staff establishment of n=429 and ODI District hospital has 401
(n=19) in a staff establishment of n=474 This trend of vast differences in figures
represented by the occupational groups is evident in the category of professional nurses
where George Mukhari Hospital reflects 1931 (n= 548) nurses Tara Moross Centre is
represented by 1754 (n=47) Germiston by 1889 (n=81) and ODI District hospital by
23 (n=109) The impact of absenteeism is pronounced when viewed against the level of
facility capacity in terms of human resources of the core occupational groups
441 The Tara Moross Centre Hospital
Tara Moross Centre Hospital is a speciality psychiatric hospital in Region A with a workforce
of 669 (n=268) of the total workforce (n=4010) The core function of the hospital is
specialised such that some occupational categories are not available in the hospital as part
of the workforce and patients are referred out to other facilities for specialised treatment
Tara Moross Centre Hospital falls under the jurisdiction of the Johannesburg Metropolitan
Municipality
442 The Germiston Hospital
Germiston Hospital is a regional general hospital in Region B with a total permanent staff
establishment of 1070 (n= 429) of the total workforce (n=4010) The hospital falls under
the Ekurhuleni Metropolitan Municipality It does not have occupational therapists clinical
psychologists dieticians speech therapists and dentists in its permanent staff
443 The ODI District Hospital
The ODI District Hospital is in Region C and is in transition due to boundary changes It is
being transferred from the North West Province to the Gauteng Province The hospital is in
a semi-rural area with a staff component of 118 (n=474) of full-time employees (n=4010)
and falls under Tshwane Metropolitan Municipality It is a general district hospital
444 The George Mukhari Hospital
The George Mukhari Hospital is an academic hospital in Region C under Tshwane
Metropolitan Municipality The hospital trains doctors and employs 010 (n=3) White male
employees 26 (n=739) African males and7184 (n=2097) African females out of the
total female workforce (n=2919)
46
This phenomenon may be as a result of the hospital having the highest general assistants
workforce at 2065 (n=586) out of the workforce (n=2839) The George Mukhari Hospital
has the highest number of general assistants out of the four hospitals represented as 25
(n=719) in a total workforce of n=2836 African employees
45 RESEARCH INTERPRETATION
The interpretation of leave of absence is confined to salary level 1 to 12 full time employees
of the Gauteng Department of Health who took leave of absence from the workplace for the
calendar year in 2008 It excludes the contract employees periodic remuneration foreign
employees and permanent employees above salary range 13
The Basic Conditions of Employment Act 75 of 1997 Section 9 (3) (RSA 1997) prescribes
procedures in terms of progressive reduction of the maximum working hours to the goal of
a 40-hour working week and an eight-hour working day Finnemore and Van Rensburg
(2002462) state that the reduction of maximum working hours to 40 hours a week is done
through collective bargaining with due regard to job creation efficiency and health safety
and welfare of employees Du Toit and Van Der Waldt (1998232) use the formula to
aggregate lost working-man hours due to ill health and disability as aggregate lost hours in
the survey period divided by 40 hours in a week and x number of hours in a year A formula
to work out the absenteeism rate by Pierce (2009) is represented as A=BC A= Absenteeism
rate B= Total number of days lost due to absenteeism in a given period C= Total number of
working- man days available in the given period C=D x E D=Total number of employees
planned to work in the given period E=Number of available working days in the given
period
The approach of the research uses the principle of absence from the workplace when due to
work to identify the lost working hours (Pierce 2009 Davey amp Cummings 2009313) The
study applies a retrospective approach
The working-man lost days for the Province in the four hospitals is approached in terms of
lost working -man days simplified refers to the number of days meant to have been worked
but actually not worked due to illness or disability by the employees in a year divided by the
total number of employees of the public sector (PXVI) Barker (200779) argues that a
reduction in working hours increases the hourly cost of production and unit production
unless there is a commensurate increase in productivity This approach has a similar effect
on workplace absenteeism when the workload of those employees who are present
increases as they carry the double load to meet the demands of service delivery The cost of
absence to the Province is expressed as salary expenditure for each day of leave of absence
from the workplace (PSC 2002 xiii Pierce 2009)
47
The salary range is laid down according to Annexure in DPSA Circular 1 of 2008 The Gauteng
Government experienced a cost estimated at R29 million in 2000 and approximately R54
million in 2001 from absenteeism and loss of working time (Parbhoo20031)
The formula that is used in this research to calculate lost man work-hours is collective
working days of absence multiplied by 8 hours in a working day resulting in the total
working hours that are lost This formula can be represented as
Lost days x hours (8) in a working day = lost working hours
As stipulated by the Basic Conditions of Employment Act 75 of 1997 section 9 1(c) 3
TABLE 6 RACES IN RELATION TO ABSENTEEISM
RACE TOTAL DAYS OF ABSENTEEISM PERCENTAGE
Africans 14295 963
Whites 242 16
Coloureds 201 14
Indians 102 07
TOTALS 14840 100
(Source Compiled by the researcher 2012)
Table 6 represents absenteeism in the diverse races in the workplace The absenteeism rate
seems to be proportional to the number of employees The Employment Equity Act 55 of
1998 defines the term ldquoblackrdquo as a generic term which means Africans Coloureds and
Indians The Africans as a race group is represented by 963 (n=14295) of the total
working days lost (n=14840) The high figure of lost working-man days reflects the
demographics of the four hospitals The George Mukhari Hospital is in a rural setting that is
predominantly African populated and employs the highest number of Africans as
represented in table 3 Whites are presented by 16 and not represented in all
occupational categories and salary ranges that could explain the low figures and
percentages associated with working-man days lost Africans constitute the highest number
of employees as well as the highest percentage of working-man days lost Absenteeism
percentage is proportional to the employment figures for this race group The Indian race
group is represented by the lowest figure of employment and lowest percentage of leave of
absence which is proportional to the employment figure
48
TABLE 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM
OCCUPATIONAL
GROUPS
TARA GERMISTON ODI GEORGE
MUKHARI
TOTALS
DOCTORS 22 118 5 290 435
PROFESSIONAL NURSE 272 346 20 2459 3097
STAFF NURSE 128 247 13 1568 1956
NURSE-ASSISTANT 150 126 25 1145 1446
FINANCE 0 0 0 386 386
ADMINISTRATION 57 272 20 1923 2272
ADMIN SUPPORT 754 547 163 3784 5248
TOTAL 1383 1656 246 11555 14840
(Source Compiled by C S Ndhlovu 2012)
Table 7 reflects the working-man days lost by the different occupational groups The
doctorsrsquo workload in terms of the annual report for Gauteng Department of Health
(2008951) was 226 as against the target of 227 while the national target was 187
The bed occupancy rate target for the same time was 75 while the actual figure was
653 The annual report interpreted in conjunction with the data of leave of absence for
doctors reflects a negative impact in terms of service delivery and the cost factor to the
department
451 Occupational groups in relation to absenteeism
The multi-group invariance structural model presents different types of occupations and is
used to identify variance in the patterns in terms of occupational groups The model allows
different relationships between variables in different occupations The different
occupational groups are doctors professional nurses and sub-categories administration
staff and administration support staff (Pousette amp Hanse 2002230) According to Gaudine
and Gregory (2010599) absenteeism was a problem among health care workers in
comparison to other employees in other sectors The cornerstone of an efficient health care
service delivery is equity and efficiency which is threatened when employees are not at
work when expected to be (Andrews 199734-35 DPSA 1997)
49
According to the Charted Institute of Personnel Development (200811) the survey that was
conducted found that public sector employees are less likely to be disciplined or dismissed
for reasons of workplace absenteeism
Tables 5 and 6 and 7 reflect the different occupational groups and the level of absenteeism
in the four hospitals of the Gauteng Department of Health
4511 Doctors
Doctors are represented by 10 (n=397) of the total working population (n=4010) The
29 (n=435) indicates the number of working-man days lost in relation to the total
working- man days lost (n=14840) The percentage of working- man days lost in relation to
the total number of full time employees of the four hospitals is reflected as 435 divided by
n=4010 times the percentage which results in 108 (n=435) working-man days lost
multiplied by 8 hours that represent a working day The outcome is n=3480 working-man
hours The cost to the Province is calculated in terms of the salary expenditure as direct and
indirect salary payment for lost working-man hours estimated at 3480 hours at salary level
10 at R217 482 to salary level 12 at R 407745 as well as indirect costs such as replacement
of staff and overtime
The doctorsrsquo workload in terms of Gauteng Province 20089 annual report (2008951)
reflects the doctorrsquos workload as 226 as against the target of 227 while the national
target is reflected as 187 The bed occupancy rate target for the same time is 75 while
the actual target rate is 653 The annual report when interpreted in conjunction with the
data of leave of absence for doctors reflects a negative impact in terms of service delivery
and the cost factor to the Department when considering a loss of n=3480 man hours of
work
Chaudhury and Hammer (200311) found in their research that the doctors presented the
highest absenteeism rate Serneels et al (2008210) argue that absenteeism is rife in the
public sector where employees hold two jobs and is highest among doctors The doctor
absenteeism rate in the research does not stand out as high in comparison with the other
occupational groups The doctor absenteeism rate is 29 when compared to the total
workforce This occupational group is represented by 10 of the total population The
doctorsrsquo absenteeism rate does not seem to be outstandingly high in comparison with the
other occupational groups in relation to the total number of permanent doctors
50
4512 Professional nurses
The professional nursesrsquo absenteeism is reflected as 208 (n=3088) that indicates the
number of working-man days lost in relation to the total working-man days lost (n=14840)
The percentage of working-man days lost in relation to the total number of full time
employees (n=4010) in the four hospitals is reflected as 77 The cost to the Province
translates into direct and indirect salary expenditure which is spread from salary level 4 to
12 at R64 410 to R407 745 in 2008 for the total duration of lost working days
Du Toit and Van Der Waldt (1998232) pointed out a crisis in four other public hospitals in
the Gauteng Province that was caused by budget cuts and shortage of doctors and nurses in
2008 The vacancy rate of 697 in the professional nurse category and the absence rate of
208 in 2008 in the four hospitals seem to point to a lack of adequate human resources for
effective health care delivery The extent of working-man hours lost in the findings of the
research suggest a high rate of absenteeism and not a good reflection of happiness as
suggested in the annual report Professional nurses are second to the administration
support in absenteeism at 208 at a total of (n=785) nurses in the four hospitals with
absenteeism of n=3088 working-man days lost or n=20704 working-man hours lost This
category of employees is classified as skilled to highly skilled at salary range of 4 to 12The
total vacancy rate was at 697 as against the national target at 15 in 2008 with
absenteeism of 208 Madibana (201022) found in the research about absenteeism
among nurses that the high rate of absence had a negative impact in the quality of health
care rendered by nurses
4513 Staff nurses
Staff nurses are reflected in tables 4 and 5 as representing 12 (n=482) of the total working
population (n=4010) The 132 (n=1956) indicates the number of working-man days lost
in relation to the total working-man days lost (n=14840) times the percentage
The percentage of working-man days lost in relation to the total number of full time
employees in the four hospitals is reflected as 488 The cost to the Department is
expressed as direct and indirect salary expenditure for n=15648 working-man hours lost
The impact of leave of absence to health care services and cost to the Department is the
same as the professional nurses as staff nurses are a sub-category of the nursing profession
4514 Nursing assistants
Nursing assistants are reflected in tables 4 and 5 as represented by 107 (n=429) of the
total working population (n=4010) and 97 (n=1446) represent working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The
percentage of working-man days lost is reflected as 36 (n=1446) in relation to the total
number of employees in the four hospitals (n=4010)
51
The cost of leave of absence to the Department is expressed as the salary expenditure at
salary levels 3 to 6 Salary level 3 is at R54 876 salary level 4 is at R64 410 salary level 5 at
R76 194 and salary level 6 is at R94 000 for n=11568 working-man hours lost and staff
replacement and overtime
4515 Finance officers
Finance officers are reflected in tables 5 and 7 as represented by 21 (n=83) of the total
working population (n=4010) and 26 (n=386) indicates the working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The cost to the
Department is reflected as salary expenditure from salary level 2 at R47 787 to salary level
10 at R217 482 for R2 728 working hours lost The institutions reflected a small number of
this occupational category as permanent employees place them in the category of scarce
skills
4516 Administration staff
The administration staff is represented in tables 2 and 4 and 5 by 116 (n=466) in the total
working population (n=4010) and 153 (n=2272) indicates the working-man hours lost in
relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 567 represent the working-man days lost in relation to the total number of
full time employees in the four hospitals (n=4010) The cost of leave of absence to the
department is reflected as salary expenditure at salary level 4 to 12 Salary 4 at R64 410 to
salary level 12 at R407 745 for 18176 working hours lost
4517 Administration support
The administration support is reflected in tables 2 and 4 and 5 as represented by 273
(n=1095) of the total working population 354 (n=5248) indicates the working-man days
lost in relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 1309 (n=5248) indicates the working-man days lost in relation to the total
number of employees in the four hospitals (n=4010) The total cost to the Department is
reflected as salary expenditure at salary level 2 to 3 at a cost of R47 787 to R54 879 for
41984 working -man hours lost
The highest percentage of absenteeism in the different categories of employees in the four
hospitals is identified in the administration support category It is this category that falls into
the salary range of 2 and 3 which is classified in the Gauteng Province 20089 annual report
(20089325) as lower skilled employees This category represents the highest single
category of employees for the Department at n=1095
52
The impact to the core service delivery employees that require support from administration
staff would seem to be negative as the absence of employees from the workplace would
hamper the smooth workflow Barker (2007214-224) acknowledges the decline in the flow-
through rate in the school education higher grades namely Grade 11 and Grade 12 and
ventures to give possible reasons for this phenomenon The Gauteng Department of Health
as a possible employer has attracted a high percentage of the labourer category as
identified in table 3 totalling n=1095 which is 273 of the total workforce Pousette and
Hanse (2002230-231) suggest that the employeersquos authority to make decisions in his or her
job and the breadth of use of skills used by the employees at work become different aspects
of control with human service at work This approach suggests that reduced job autonomy is
associated with higher sickness absence The administrative support employees are involved
in mechanical or manual labour that predisposes them to musculo-skeletal problems The
work environment could have a negative impact to the high absenteeism rate in this group
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM AS REPRESENTED BY
THE HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 43 reflects the absenteeism rate of the different occupational groups as represented
by the hospitals The George Mukhari Hospital contributes 7079 to the total workforce
and contributes about 779 to absenteeism The absenteeism rate does seem to be low at
7 when considered in the light of the contribution The question that maybe be raised is
whether the relative low absenteeism is indicative of high morale of a happy workforce
53
ODI 17
TARA 93
GERMISTON 111
GEORGE MUKHARI 779
Germiston Hospital contributes 106 to the total workforce and the absenteeism is
reflected as 111 which seems to be above its contribution to the workforce by 1 The
professional nurse and the administration category present with the highest rate of
absenteeism in this hospital The Tara Moross Centre Hospital contributes 67 of the total
workforce and the absenteeism rate is at 93 which is 26 higher The administration
support and professional nurses present with the highest level of absenteeism in this
hospital The ODI Hospital contributes 6 to the total workforce and the absenteeism rate
which seems to be low is reflected as 17 This hospital has no access to the Persal system
and is dependent to a neighbouring hospital It is highly probable that the information is not
accurate
Allen (1984 331) found that union members might be absent more frequently from the
workplace than non-members because they face smaller penalties for absenteeism The
Charted Institute of Personnel and Development (CIPD) (200811) claim that the 2006
survey of absence management portrays the public sector employees as less likely to be
dismissed for reasons of workplace absenteeism
TABLE 8 SALARY RANGE IN RELATION TO ABSENTEEISM (SALARY RANGE 1-12)
SALARY RANGE DAYS OF ABSENCE PERCENTAGE
1-2 178 12
3-4 5235 353
5-6 2044 138
7-8 5139 346
9-10 1878 126
11-12 366 25
TOTAL 14840 100
(Source Compile by the researcher C S Ndhlovu 2012)
Table 8 reflects the salary range with the lowest working days lost as salary level 1 to 2 This
is proportional to the number of employees The highest absenteeism rate has been noted
in the salary range at level 3 to 4 while salary ranges at level 11 to 12 reflected a low rate of
absenteeism The latter salary range is at middle management level and the responsibility
the employees carry may be responsible for the low absenteeism rate Rogers and Hertin
(1993219) noted that the level of education seem to have influenced the use of sick leave
where the lower level category employees were found to have higher level of absenteeism
than higher educated employees
54
TABLE 9 AGE IN RELATION TO ABSENTEEISM
AGE IN YEARS DAYS OF ABSENCE PERCENTAGE
20 to 24 16 010
25 to 29 405 272
30 to 34 733 493
35 to 39 1582 1066
40 to 44 2676 1803
45 to 49 3318 2235
50 to 54 3046 2052
55 to 59 2235 1506
60 to 64 829 558
TOTAL 14840 9999(100)
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 9 reflects age in relation to absenteeism in the four hospitals The age group at 20 to
24 years reflects the lowest figure in working-man days lost at 010 (n=16 days)
Reday-Mulvey (200579) observed that employees over 45 years take marginally fewer short
sick leave days per year than those under 45years
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 to 55 years
as middle -age and shows this group as presenting with a high incapacity leave usage In the
research the age group 45 to 49 years presented with 2235 (n=3318) working-man days
lost and is the highest figure of absenteeism in all age groups The age group at 20 to 24
years is reflected as the lowest absenteeism rate in working-man days at 010 and this
could be related to the number of employees in this age group
According to Reday-Mulvey (20057988) and the Canadian Nurses Association (20065)
employees that are over 45 years take marginally fewer short sick leave periods but take
slightly longer sick days per year than those under 45 years and reflect higher absenteeism
in the age group above 50 years
55
Weeks (200454) found that employees at the age group represented by 51 to 60 years
show less absence which may be because of ill health retirement benefits The age 31 to 40
and 41 to 50 years show higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full time jobs and suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee In the study the age group 55 to 59 years show a decline in absenteeism in
comparison to 50 to 54 while age 60 to 64 shows the lowest rate
The aging employee has been found to expose the institutions to high levels of absenteeism
through a higher probability of becoming incapacitated for longer periods (Ferguson et al
200138) and the current research have pointed differently Rogers and Hertin (1993219)
found a significant correlation between the use of sick leave and age suggesting employees
with advanced age used more sick leave in comparison with the younger employees The
current socio-economic culture encourages retirement from active employment at the age
of 65 years and the research adopted that approach as a cut off point for employment
(Nichols amp Evangelisti 2001285)
TABLE 10 GENDER IN RELATION TO ABSENTEEISM
GENDER TOTAL
NUMBER
DAYS OF
ABSENCE
PERCENTAGE
Males 1006 2490 168
Females 3004 12350 832
Total 4010 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 10 reflects gender in relation to absenteeism The duration of working-man days lost
is higher in female employees at 8325 (n=12350) and is represented by 749 (n=3004) in
relation to the total number of employees in the four hospitals (n=4010) as represented in
table 3 The male employees employed by the Department are reflected as absent from
work by 1680 (n=1006) and represented as 251 in relation to the total number of
employees in the four hospitals (n=4010)
The Public Service Commission (PSC 200222) found that more males took sick leave than
females except for the age group of 16 to 19 years QUALSA (200923) noted that females
had the highest number of incapacity applications in comparison to their male counterparts
Qualsa attributed this pattern to the fact that female employees constitute a higher
percentage of the employee population within the Gauteng Department of Health
56
Roger and Hertin (1993222) noted that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees could have an
impact on the high number of absenteeism reflected by the women
452 Race in relation to absenteeism
The working population of the four hospitals is represented by four race groups such as
Africans Whites Coloureds and Indians
4521 Africans
Africans represent 973 (n=3902) of the total working population (n=4010) and 963
(n=14295) indicates the working-man days lost in relation to the total working-man days
lost (n= 14840) times the percentage 3565 (n= 14295) reflects the working-man days
lost in relation to the total number of employees in the four hospitals (n=4010) The 14295
working-man days lost are multiplied by 8 hours that represent a day and translates into
963 (n=114360) working-man hours lost The cost to the Department is translated as
salary expenditure for n=114360 workingndashman hours lost and the indirect cost of staff
replacement and overtime Africans constitute the highest number of employees as well as
the highest percentage of working-man hours lost Absenteeism percentage is proportional
to the employment figures for this race group
4522 Whites
Whites are represented as 13 (n=51) of the total workforce (n=4010) and 16 (n=242)
represent the working-man days lost in relation to the total working-man days lost
(n=14840) times percentage 61 (n=242) represent working- man days lost in relation to
the total number of employees in the four hospitals The 232 working-man hours lost are
multiplied by 8 hours that represent a working- man day that translates into 16 (n=1856)
working-man hours lost The cost to the Department is represented as salary expenditure of
(n=1856) working-man hours lost that is paid to the unproductive employees This race
group of employees is not represented in all occupational categories and salary ranges
which may explain the low figures and percentages associated with working-man days lost
(n=242) The demographics of the different hospitals may contribute to the low
representation of this group in the total workforce
4523 Coloureds
Coloureds are reflected as 11 (n=43) of the total workforce (n=4010) 14 (n=201)
represent working- man days lost in relation to the total working- man days lost (n=14840)
5 (n=201) indicates working- man days lost in relation to the total number of employees in
the four hospitals (n=4010)
57
The cost to the department is represented as salary expenditure for n=1608 working-man
hours that are lost This race group is represented in three of the four hospitals and not in
all categories and salary ranges which may explain the low representation and
absenteeism
4524 Indians
Indians represent 03 (n=14) of the total workforce (n=4010) in table 6 07 (n=102)
represent working- man days lost in relation to the total working- man days lost (n= 14840)
times percentage 25 (n=102) indicates working- man days lost in relation to the total
number of employees in the four hospitals (n=4010) The 102 working- man days lost are
multiplied by 8 hours that represent a working-man day and translates into 07 (n=816)
working- man hours lost The cost to the Department is expressed as salary expenditure
paid to the unproductive employees for duration of (n=816) working-man hours lost This
race group is not represented in two of the four hospitals in some occupational categories
and salary ranges The Indian race group is represented by the lowest figure of employment
and lowest percentage of leave of absence which is proportional to the employment figure
FIGURE 44 RACES IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 44 reflects the different races in relation to absenteeism The Africans as a race
group is represented by 963 of working-man days lost (n=14840) The high figure of lost
working-man days reflects the demographics of the four hospitals
58
14840 DAYS
(100)
Africans 963
whites 16
coloureds 14
Indians 07
The George Mukhari Hospital is in a semi-rural setting that is predominantly African
populated and employs the highest number of Africans as represented in table 1 (n=2836)
Whites are presented by 16 absenteeism rate and not represented in all occupational
categories and salary ranges which could explain the low figures and percentages associated
with lost working days The absenteeism rate for Indians is represented as 07 and
Coloureds as 14
The Africans as a race group constitute the highest number of employees as well as the
highest percentage of working days lost Absenteeism percentage is proportional to the
employment figures for this race group The Indian race group is represented by the lowest
figure of employment and lowest percentage of leave of absence which is proportional to
the employment figure The South African Survey Millennium (1999-200028) reflected the
African males in 1998 as 354 and females as 348 the Coloured males as 39 and
females as 46 Indian males as 39 and females as 15 and White males as 83 and
females as 94 There has been no significant change in the race group representation in
the working population of the four hospitals
453 Tenure in relation to absenteeism
Tenure in years is grouped in units of ten (10) Tenure in 1 to 10 years 11 to 20 years 21 to
30 years 31 to 40 years of all occupational groups are represented in figure 27 as the total
leave of absence utilised by the full-time employees of different occupational groups in
terms of tenure which translates into n=14840 working-man days lost The lowest hours lost
is at tenure 31 to 40 years of service which is reflected as 59 (n=878) working- man days
lost The highest working-man days lost is at tenure of service of 11 to 20 years reflected as
443 (n= 6577) working- man days lost Tenure of service of 1 to 10 years reflects 30
(n=4451) working-man days lost and tenure of years at 21 to 30 years reflects 198 (n=
2934) working- man days lost
Rogers and Hertin (1993222) express tenure as work experience in years that is viewed as a
predictor of employee productivity where seniority has been found to be inversely related to
absenteeism in terms of frequency and total number of work days lost The Canadian Nurses
Association (20065) suggests that job tenure increases with age as illustrated in their
research where nurses were found to have both job tenure of 20 years or more and are over
45 years of age In the research the tenure of 31 years to 40 years presented with the lowest
absenteeism rate in agreement with Rogers and Hertin (1993222)
59
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 45 reflects the total leave of absence from tenure of 1 year to 40 years The PERSAL
system reflected 40 years as representing more or less 64 years of age and 65 years is the
cut off point for full time employees in the system The lowest working- man days lost is at
tenure of 31 to 40 years of service which is reflected as 590 and represents the older
employee in general The highest working- man days lost is reflected at tenure of 11 to 20
which is presented as 4430 representing the younger employee This is an area of concern
as table 5 reflects professional nursesrsquo absenteeism rate at 208 and administration
support staff at 356 and is possible that the absenteeism rate of the two occupational
categories may be a bigger contributor to the high absenteeism rate reflected in the tenure
of 11 years to 20 years
454 Salary range in relation to absenteeism
The salary range is interpreted in the study as a salary broad band that is represented in
table 9 and ranges from level 1 to 12 Rogers and Hertin (1993 219) claim that the level of
education does seem to have a bearing on the salary range use of sick leave where the
lower level category employees were found to have higher levels of absenteeism than the
higher educated employee The Human Resource Development Strategy (Gauteng Province
200815214) claims that the chances of entering into a higher income bracket in South
Africa rises noticeably after people have twelve years of education The ages 20 to 24 years
are greatly affected by this assumption
60
0
20
40
60
Tenure 1-10Tenure 11-20
Tenure 21-30Tenure 31-40
30 4430
1980
590
Tenure
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 46 above reflects the salary range from 1 to 12 in relation to working- man days lost
as salary range 1 to 2 as n=178 working-man days lost which converts to 12 The highest
absenteeism rate has been noted in the salary range at level 3 to 4 at 3530 (n=5235)
working-man days lost while salary ranges at level 7 to 8 is reflected as the second highest
level of absenteeism at 346 (n=5139) lost working-man days
Salary range at 5 to 6 is reflected as the third highest in absenteeism at 138 (n=2044) lost
working-man days Salary range 9 to 10 is regarded as the entry point to middle
management and is reflected as the fourth highest at 126 (n=1878) working-man days
lost Salary range at 11 to 12 is regarded as middle management entrusted with high levels
of authority and accountability This group is reflected as losing 25 (n=366) working- man
days lost which is considered to be a reasonable low level of absenteeism
455 Age of full time employees in relation to absenteeism
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 years to 55
years as middle-age and shows this group as presenting with a high incapacity leave usage
In the research the age group of 45 years to 49 years is represented with 2235 (n=3318)
working- man days lost and is the highest figure of absenteeism in all age groups
61
178
5235
2044
5139
1878
366
0
1000
2000
3000
4000
5000
6000
Salary range1-2
Salary range3-4
Salary range5-6
Salary range7-8
Salary range9-10
Salary range11-12
DAYS OF ABSENTEEISM
Reday-Mulvey (20057988) and Canadian Nurses Association (20065) observed that
employees over 45 years take marginally fewer short sick leave periods but take slightly
longer sick days per year than those under 45 years and reflect higher absenteeism in the
age group above 50 years
Weeks (200454) claims that the age group at 51years to 60 years show less absence may be
because of ill health retirement benefits The age group of 31 years to 40 years and 41years
to 50 years show a higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full-time jobs He suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee The aging employee has been found to expose the institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods
(Ferguson et al 200138)
Rogers and Hertin (1993219) claim that there is a significant correlation between the use of
sick leave and age suggesting employees with advanced age comparatively used more sick
leave in comparison with the younger employees The current socio-economic culture
encourages retirement from active employment at the age of 65years and the research
adopted that approach as a cut off point for employment (Nichols amp Evangelisti 2001285)
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 47 reflects the number of working-man days lost by full-time employees through
absenteeism related to a specific age
62
16
405
733
1582
2676
3318
3046
2235
829
0
500
1000
1500
2000
2500
3000
3500
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Days of absence
Days of absence
Age groups are organised in units of 5 to be consistent with the Personnel and Salary
Administration System (PERSAL) The age group at 20 years to 24 years reflects the lowest
percentage of absenteeism at 010 (n=16) working-man days lost and the age group of 45
years to 49 years reflect the highest days of absenteeism at 2235 (n=3318)
456 Gender in relation to absenteeism
The females employed in the Department of the four hospitals are represented as 749
(n=3004) in relation to the total number of employees in the four hospitals (n=4010) and
lost 8320 (n=12350) working-man days This absenteeism rate is considered high
considering that not every female employee may have used sick leave The male employees
employed in the Department are represented by 25 (n=1006) of the total workforce
(n=4010) and lost 168 (n=2490) working-man days The findings suggest that males
utilised fewer days of sick leave considering the fact that not every male employee may
have utilised sick leave for the duration of the study
The Public Service Commission (PSC 200222) claims that more males took sick leave than
females except for the age group of 16 years to 19 years QUALSA (200923) noted that
females had the highest number of incapacity applications compared to their male
counterparts Qualsa attributed this pattern to the fact that female employees constitute a
higher percentage of the employee population within the Gauteng Department of Health
Rogers and Hertin (1993222) argue that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees may have an
impact on the high rate of absenteeism
63
FIGURE 48 GENDER IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 48 reflects gender in relation to absenteeism The females employed by the
department in the four hospitals are reflected as absent from work at a rate of 8320
(n=12350) working-man days and represented by 749 (n=3004) in relation to the total
number of employees (n=4010) in the four hospitals The male employees employed by the
Department are reflected as absent from work at 1680 (n=2490) and represented as
251 (n=1004) in relation to the total number of employees in the four hospitals
(n=4010)
457 Week days in relation to occupational groups
Table 11 reflects the trends in terms of days of the week that show high utilisation by the
different occupational groups Mondays Fridays and Thursdays reflect a high utilisation rate
by the employees suggesting a pattern of high absenteeism rate over weekends
Professional nurses and sub-categories and the administration support group reflected the
highest absenteeism over the weekends
64
1680
8320
000
1000
2000
3000
4000
5000
6000
7000
8000
9000
Males Females
GENDER ABSENCE
TABLE 11 WEEK DAYS IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
OCCUPATIONAL
CATEGORY
MONDAY TUESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Doctors 18 8 13 17 0 0
Professional
Nurse
135 86 94 137 0 0
Staff Nurse 52 38 56 65 2 0
Nursing
Assistant
62 27 34 45 2 0
Administration
Staff
64 38 58 73 1 0
Administration
support
252 147 98 126 26 15
Finance officer 17 4 8 16 0 0
TOTAL 600(4) 348(23) 361(24) 479(32) 31(02) 15(010)
(Source Compiled by C S Ndhlovu 2012)
Table 11 reflects the pattern of how the different occupational groups utilised sick leave on
the different days of the week It illustrates the days that sick leave started on each day of
the week The largest number of incidences of sick leave commence on Monday the first
working day of the week as reflected by 4 (n=600) of the days of the weekend Fridays are
the second highest days of absenteeism represented by 32 (n=479) Tuesdays and
Thursday are almost the same in utilisation as reflected by 23 and 24 respectively
Professional nursesrsquo absenteeism was pronounced on Mondays as 2250 (n=135) and
Fridays as 2861 (n=137) a trend that shows possible long weekend absenteeism
The administration support staff has been reflected as mostly absent on Mondays 42
(n=252 days) and Fridays 2631 (n=126 days) The administration support reflected the
highest days of absenteeism on Saturday (n=26) and Sunday (n=15) The Canadian Nurses
Association (CNA) (2006) focused on seasonal pattern of absenteeism in the different
categories in the different hospitals The PSC (2002) report identified a trend by provincial
employees of using sick leave to extend their weekends The research considered working-
man days lost in terms of days of absence as in accordance with evidence of a medical
certificate Administration support is the only group that seem to have utilised Saturdays
for sick leave 8387 (n=26) and Sundays 100 (n=15) days
65
TABLE 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALS
INSTITUTIONAL
CONTRIBUTION
TARA MOROSS
CENTRE
GERMISTON ODI GEORGE
MUKHARI
TOTAL
Contribution to
Sample
668 1070 1182 7080 100
Contribution to
Absenteeism
842 1177 165 7816 100
(Compiled by C S Ndhlovu 2012)
Table 12 reflects the contribution of each hospital to absenteeism Tara Moross Centre
Hospital contributed 67 to the sample and the absence rate is higher than the
contribution at 84 The Germiston Hospital contributed 107 to the sample and the
absenteeism rate is higher at 117 The George Mukhari Hospital contributed 708 to the
sample and absenteeism rate is at 782 and ODI Hospital contributed 118 and
absenteeism rate is at 17 The latter hospital has no computers at The reflection of the
status of absenteeism is likely to be inaccurate The George Mukhari Hospital has the
highest contribution to the sample yet leave of absenteeism is tolerable It raises questions
as to what should be the contributory factor to the leave of absence status in this hospital
46 CONCLUSION
Chapter 4 presented the analysed data in terms of the characteristics as determined in the
stratified random sampling The characteristics and their association with absenteeism have
been presented such as occupational categories age gender tenure of service and race
The research identified which days of the week were utilised for sick leave absence The
contribution of each hospital to absenteeism was identified and a brief overview of each
hospital was presented
Chapter 5 presents the findings conclusion and recommendation of the research
66
CHAPTER 5
FINDINGS CONCLUSIONS AND RECOMMENDATIONS
51 INTRODUCTION
Chapter 1 provides a general introduction to the research It included the background and
motivation for the research that provides the context the problem statement and the
significance of the research The key concepts are defined The research design the method
of data collection the sampling method data analysis and interpretation and limitations to
the research are explained in this chapter
Chapter 2 considers the theoretical foundations concepts characteristics theories
approaches and classifications of workplace absenteeism The discussions on the conceptual
framework of absenteeism predictors of absenteeism and various models of absenteeism
are presented Measures to control workplace absenteeism and the impact of absenteeism
in an institution and management intervention strategies in workplace absenteeism were
discussed
Chapter 3 describes the research design and the different aspects of the research methods
that were applied to the research The chapter explains the various data collection
techniques that are used unit of analysis units of observations construct validity and
ethical considerations
Chapter 4 provides the organisational structure of the Gauteng Department of Health
comparisons of hospital employees different race groups of the four hospitals gender
comparisons in different hospitals and comparisons of the different occupational groups It
provides a short description of the target hospitals The research interpretation is discussed
in terms of the different occupational groups and absenteeism different races and
absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism The trends of week days of
absenteeism in the four hospitals and contributions to absenteeism by the four hospitals are
presented
Chapter 5 explains a synthesis of the study and evaluation of workplace absenteeism The
findings of the research and recommendations are discussed
52 FINDINGS
The findings of the research reflect doctors as represented by 108 in the total workforce
(n=4010) have an incidence of 29 (n=435) of the total work-man days lost (n= 14840) by
the employees in the four hospitals translating to a total of n=3480 working hours lost
67
The working-time lost is considered against the doctorsrsquo workload of 226 in contrast to the
target of as 227 while the national target was 187 The bed occupancy rate target was 75
while the actual figure was 653 The annual report when it is interpreted in conjunction
with the sick leave absence of doctors at 29 shows no negative impact on the workload in
terms of service delivery The negative impact is mainly on the cost factor to the state as the
doctorrsquos salary level is from salary level 10 at a cost of R217482 to salary level 12 at
R407745 (Gauteng Province annual report 2008951) Serneels et al (2008210) claim that
absenteeism occurs primarily in the public sector associated with people who hold two jobs
and that is highest and more frequent amongst doctors The findings of the research of
absence of 29 with a contribution of 2 to the sample are in disagreement with the
Serneels et al findings
Professional nurses represent 196 (n=785) of the total workforce (n=4010) The
workplace absenteeism is represented as 77 (n=3088) of the total workforce (n=4010)
translating into 21 of working-man days that are lost (n=14840) The absenteeism rate
appears to be very high given the fact that nurses by virtue of their numbers are the
backbone of health care service delivery (DPSA 2009) The Gauteng Province annual report
of 2008951 reflects the total vacancy rate of nurses at 697 as against the national target
of 15 The absenteeism rate of 77 is very high when compared with the total vacancy
rate and 19 contribution to the sample Staff nurses are a sub-category of the nursing
profession and the impact of their absence to service delivery is the same as the
professional nurses The findings of the study reflect staff nurses representing 12 (n=482)
of the total working force (n=4010) The absenteeism from staff nurses is reflected as 13
(n=1956) of the total working-man days lost (n=14840) The absenteeism rate does appear
to be high when considering the contribution of 13 to the absence rate by a sample of 12
to the total working-man days lost Nursing assistants are a sub-category of the nursing
profession that is reflected as 107 (n=429) of the total number of employees (n=4010)
and represent 97 (n=1445) of the total working-man days lost (n=14840) This absence
rate is considered as high when compared with the total number of employees
The nursing occupational group considered collectively contributed to absenteeism at the
workplace at 997 which is extremely high Davey and Cummings (2009312-313) claim
that frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased
staff morale and high cost to health care The high absenteeism rate has a negative impact
on health care service delivery
The findings of the research reflect administration staff as 116 (n=466) of the total
number of employees (n=4010) represented by 154 (n=2286 days) of the total working-
man days lost (n=14840) Administration support is at salary level 1 to 2 with exceptional
instances of salary level 3 to 4
68
Administration support staff is reflected as 273 (n=1095) of the total workforce (n=
4010) represented by 356 (n=5289 days) of the total working-man days lost (n=14840)
translating to n=42312 lost working-man hours
The administration staff viewed collectively contributed 51 to absenteeism which is very
high with the support staff reflected as 356 Rogers and Hertin (1993219) claim that the
level of education seem to have influenced the use of sick leave where the lower skilled
category of employees were found to have higher levels of absenteeism than higher
educated or skilled employees The findings of the research reflect the administration
support staff to be in line with the Roger and Hertin findings
The Gauteng Department of Health has a limited number of finance officers causing them to
be a scarce skill occupational group The finance officers represent 2 (n=83) of the total
workforce (n=4010) The working-man days lost are reflected as 23 (n=341) of the total
working-man days lost (n=14840) The total absence at 23 is higher than the actual
contribution to the sample at 2
The age group of 45 years to 49 years reflects the highest absenteeism rate at 224
(n=3318) the age group at 50 years to 54 years is reflected as 205 absenteeism The age
group 40 years to 44 years reflected as 18 absent from the workplace The age group of 55
years to 59 years is reflected as 15 absenteeism Employees of advanced age used more
sick leave in comparison with the younger employees This phenomenon could be attributed
to the ageing process of the body and the onset of incapacity Absenteeism has been found
to be higher in employees who are over 50 years of age and the phenomenon is attributed
to age and changing abilities that increase when work is performed full- time The findings
of the research reflect the age group over 50 years at 205 and reflect the highest
absenteeism rate at age 45 years to 49 years as 224 (McGoldrick amp Arrowsmith 200184
MINTRAC 20093 Nichols amp Evangelisti 2001285 Reday-Mulvey 200579-194) According to
Ferguson et al (200138) the aging employee presents with high levels of absenteeism
through higher probabilities of becoming disabled for longer periods The findings of the
study reflect absenteeism of the age group of 55 years to 59 years at 15 which is the
lowest in the age groups The Canadian Nurses Association in (20065) noted a reduction in
workplace absenteeism rate among nurses who are less than 45 years of age and an
increase in the absenteeism rate among nurses above 55 years of age According to Bangali
(20043-4) the falling rate of the older employee age group could be influenced by the
practice of early retirement or voluntary severance which was used in the 1990s as a
method of restructuring in institutions Rogers and Hertin (1993219) claim employees with
advanced age used more sick leave in comparison with the younger employees
69
The group at tenure 11 to 20 years presented with the highest level of absenteeism at
443 The employee at tenure of 21 to 30 years presented with 198 of absenteeism rate
while the employees at 1 to 10 years presented with the rate of 30 The findings of the
research reflected tenure of 31 to 40 years to have presented with the lowest absenteeism
rate at 59 (n=878 days) This low absenteeism rate could be ascribed to the fact that
numbers of employees are reduced in this group or could also be commitment to their jobs
or could have higher ambition levels to aspire to higher posts
Van Der Westhuizen (2006136) and Rogers and Hertin (1993222) express tenure as work
experience that may be viewed as a predictor of employee productivity where seniority has
been found to be inversely related to absenteeism in terms of frequency and total number
of working-man days lost The public service employees enjoy security of tenure which may
contribute to the unacceptably high levels of absenteeism (Andrews 1997221ndash222
MINTRAC 20093)
The findings of the research reflect females as 75 of the total workforce (n=4010)
represented by 832 (n=12350) of the total working-man days lost (n=14840) The males
represent 25 of the total workforce (n=4010) and are reflected as absent at 168
(n=2490) of the total days of absence (n=14840)The absenteeism rate is very high for
females in this research Rogers and Hertin (199322) and Van Der Westhuizen (2006136)
suggest that women are absent from workplace more than men are Landstad et al (20011)
found that women cleaners who received preventive personnel support depicted a
reduction in absenteeism rate Hoxsey (2010562) claims that although women presented
with a high score of job satisfaction than men they maintained higher levels of
absenteeism MINTRAC (20094ndash8) found that gender moderates the age turnover
relationship Women are more likely to remain in their jobs the older they get than men do
The findings of the research reflect Africans as represented by 26 of the working
population and utilised 963 of the total working-man days lost due to sick leave It is
possible that the overall number of Africans influenced what seems to be a high level of
absenteeism at 963 Whites represented 03 of the working population and
absenteeism is reflected as 16 of the total working-man days lost Coloureds are
represented by 03 of the working-man population and absenteeism was recorded as 14
of the working-man days lost The Indians are represented by 01 of the total working
population and are reflected as 07 of the working-man days lost
The findings of the research reflect the salary range at level 11 to 12 utilised 25 working-
man days for sick leave salary level 7 to 8 which is the supervisory level utilised 346
working-man days lost salary level 3 to 4 which is the entry level of skilled workers utilised
353 working-man days lost The findings suggest management used fewer days of sick
leave in comparison to the supervisory level and entry skilled worker level
70
This can be ascribed to the fact that they are ultimately responsible for the institutionrsquos
effectiveness and productivity
The George Mukhari Hospital contributed 708 to the sample and reflected 771
absenteeism which is relatively low in comparison to the size of the contribution It could be
that processes and procedures of controlling leave of absence are in place The Tara Moross
Centre Hospital contributed 67 to the sample and reflected 93 absenteeism rate that is
high by 26
Professional nurses reflected a trend of high absence over the weekend including
Thursdays This could be a sign of burn out and extending the period of rest from possible
high workloads resulting from high vacancy rates (Gauteng Province annual report 20089)
Nyathi (200059) and the PSC (2002) found that employees are absent from work because
they want to prolong the weekend
53 CONCLUSIONS
The absenteeism rate is very high for females in this research The aging employee presents
with high levels of absenteeism through higher probabilities of becoming disabled for longer
periods The use it or lose it approach of the current system rewards the abuse of sick leave
as it is viewed as not being beneficial by the employees to act responsibly towards the use
of sick leave
The vacancy rate of 697 in the professional nurse category and the absence rate of 208
in 2008 in the four hospitals can only suggest inadequate levels of human resource for
effective efficient quality health care services at a high cost to the Province The nurses
may not be aware of the actual absenteeism or they under-estimate it The combination of
high registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery
Professional nurses and administration support staff have absented themselves from the
workplace predominantly on Mondays and Fridays It could be for various reasons ranging
from feelings of burn out to extending the weekend
The percentage of working-man days lost in relation to the total number of full-time
employees in the four hospitals is reflected as 488 which is very high as there is no
deterrent not to abuse sick leave in the public sector The findings of the research found a
significant correlation between the occupation and use of sick leave age and the use of sick
leave gender and use of sick leave and tenure and use of sick leave
71
The biggest hospital George Mukhari presented the lowest rate of absenteeism for its size
and complexity which reflects an empowered management The Tara Moross Centre
Hospital is the smallest hospital highly specialised and presented with high rate of
absenteeism for its contribution which may be a reflection on the skills of its management
or the type of health care service that is offered by the institution
The international norm of absenteeism is 3 The research established the absence rate at
488 The Gauteng Department of Health is held at ransom by the five trade unions it has
signed agreements with and that makes it difficult for managers to manage absenteeism
The practise of Gauteng Department of Health Head office to remove managers from
institutions when there is a labour unrest exacerbates the problem of managing
institutions
The findings of the research could not establish a representative reflection of race and
absenteeism as Indians Coloured and Whites were not represented in some institutionsrsquo
demographics
54 RECOMMENDATIONS
The White Paper on Transforming Public Service holds management responsible for
delivering specific levels of services and for obtaining value for money in wider utilising of
resources This strategy is to be translated into action The Gauteng Department of Health
should probably benefit by adopting the total absence management philosophy by
cultivating a culture that is not tolerant of high levels of absenteeism through building it in
as a key performance area of the performance of all managers and all employees The
current performance dimension system should lay explicit emphasis on this aspect
The re-engagement of knowledge based and professional retirees at reasonable
remuneration levels to reward their expertise may assist in reviving good work ethics by
mentoring the new and generally young recruits The retired professionals are currently
resisting the call for re-employment on a contract basis at entry level
The Gauteng Department of Health can encourage flexitime in terms of 58 or 68 to allow
the mature employee to remain within the system with the view to share their knowledge
and skills with the young employees who may be highly qualified but lack experience This
approach may deal with the need for adequate human resources for health care delivery at
reduced cost as two employees on flexitime basis can occupy one full-time employeersquos post
Managers should use the return-to-work counselling strategy to solicit feedback from the
employee about the actual absenteeism The counselling should be on a one-to-one basis
This approach may raise self-awareness to the employees in terms of the impact of the
employeersquos absence frothed workplace
72
Currently this intervention strategy is not adequately utilised for fear of confrontation with
labour representatives
Managers should have attendance policies in place effectively communicate policies to
employees adhere to policies and procedures and use absence control strategies
consistently This approach will minimise the feeling of injustice by employees Currently the
human resource unit is challenged by a high staff turnover due to promotions from the
human resource area a situation that creates a vacuum and lack of continuity weakening
the process of empowering line managers by human resource practitioners This high staff
turnover may be controlled through upgrading of the human resource salaries as the
salaries fall out of the occupation service dispensation (OSD)
Managers in the public service are expected to be responsible and accountable for their
portfolios including management of leave of absence and should not shift it to the human
resource unit as is currently the practice It should be possible to charge a manager as an
accomplice for failing to manage the absence of employees where there is no evidence of
corrective remedial action where it has been warranted The researcher takes cognisance of
the fact that the public service is highly unionised and this approach may trigger industrial
action
The employer needs to revive on the job in-service education and training as a way of
imparting institutional values such as attendance at the workplace in partnership with
recognised labour representatives through bilateral and multilateral forums and through
institutional skills development committee which should be representative of all
stakeholders with the view to promote stability in the workplace and indirectly enhance
productivity and reduce workplace absenteeism Currently the bilateral multilateral and
skills development committees are inactive in the institutions that were targeted and
management seems to be intimidated by the militant labour representatives
High levels of absenteeism among some occupational groups do suggest a need for an active
employee assistance programmes at all hospitals Employee wellness committees are
currently inactive There is a sporadic intervention approach at some institutions where
PILIR Committees are active Employee assistance programmes should be budgeted for as a
standing on-going programme in all hospitals There is a need for a thorough research as to
why absenteeism remains high in the public service and focus on absenteeism broadly
73
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Breetzke A 2009 Managing absenteeism Available at httpwwwIrnetworkcoza
(Accessed on 05082009)
Brink H 1996 Fundamentals of research methodology for health care professionals
Kenwyn Juta
74
Brynard PA amp Hanekom SX 2005 Introduction to research in Public Administration and
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Burton JP Lee TW amp Holtom BC 2002The influence of motivation to attend and
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Managerial Issues14 (2)
Buschak M Craven C amp Ledman R 1996 Managing absenteeism for productivity SAM
Advanced Management Journal6 (1)
Camp S amp Lambert EG 2005 The influence of organizational incentives on absenteeism
Sick leave use among correctional workers Available on
httpwwweascnoaagov(Accessed on22052009)
Canadian Nurses Association 2006 Trends in illness and injury ndashrelated absenteeism and
overtime among publicly employed registered nurses Canadian Nurses Association Ottawa
Available on httpwwwcna-aiicca (Accessed on 30032009)
Chaudhury Namp Hammer JS 2003Ghost doctors absenteeism in Bangladeshi health
facilitiesWorld Bank Policy Research Working Paper 3065 May Available
onhttpecoworldbankorg(Accessed on 10072011)
Charted Institute of Personnel and Development 2008Absence managementAnnual survey
report Charted Institute of Personnel and Development July Reference 4513 Available at
httpwwwcipdcouk (Accessed on 10072011)
Cloete JJ 2004South African public administration and management2ndimpression
Pretoria Van Schaik
Clark RL 2007The emergence of phased retirement economic implications and policy
concerns Ontario John Deutsch Institute for the study of economic policy
Dagmara S 2000Whorsquos minding the hospitals Absenteeism soars HampHN Hospitals amp
Health Networks 74 (4) April 14ndash143 Available at httpwwwoasisunisaacza(Accessed on
20072011)
Davey MMamp Cummings G 2009 Predictors of nurse absenteeism in hospitals a
systematic review Journal of Nursing Management 17 312ndash330 Available on httpO-
webebscohostcomoasisunisaacza (Accessed on 30072011)
Department for Public Service and Administration1997White paper on transforming public
service delivery Pretoria Public Service Commission
75
Department of Public Service and Administration 2007 Determination on working time in
the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Determination of leave of absence
in the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Policy and procedures on incapacity
leave for ill-health retirement (PILIR)Pretoria National Office
De Wit P 2006 Reasons for absenteeism in the Department of Defence Pretoria Tshwane
University of Technology
Du Toit Damp Van Der Waldt G 1998 Public management grassroots Cape Town Juta
Du Toit D Knipe A Van Niekerk D Van Der Waldt Gamp Doyle M 2001Service
excellence in governance Cape Town Heinemann
Du Toit D Bosch D Woolfrey D Godfrey S Rossouw T Christie S Cooper C Giles
G amp Bosch C 2003Labour relations law a comprehensive guide4thedition Durban
LexisNexis Butterworths
Erasmus B Swanepoel B Schenk H Van der Westhuizen EJamp Wessels JS 2005 South
African human resource management for the public service Pretoria Juta
European Foundation for the Improvement of Living and Working Conditions
(EFILWC)1997Preventing absenteeism at the workplace Ireland Office for Official
Publication on the European Committee
Fakie SA 2005Report on the Auditor-General on a performance audit of the management
of sick leave benefits at certain national and provincial departments Pretoria Department
Public Service and Administration (DPSA)
Ferguson T D Muedder Kamp Fitzgerald R M2001 The case of total absence
management and integrated benefitsHuman Resource Planning24 (3)
Finnemore M amp Van Rensburg R 2002 Contemporary labour relations Johannesburg
LexisNexis
Gaudine A amp Gregory C2010The accuracy of nursesrsquo estimates of their absenteeism
Journal of Nursing Management 18599ndash605
Gauteng Province 2007 Human Resource Development Strategy for Gauteng for Gauteng
maximizing human capital for shared growth Pretoria Government Printers
76
Gauteng Province 20089 Annual report Pretoria Government Printers
Gauteng Province 2010 Monitoring and Evaluation Policy FrameworkGauteng Provincial
Government Office of the Premier
Ghauri P Gronhaug Kamp Kristianslund I 1995 Research methods in business studies
England Prentice-Hall
Goldsmith Mamp Morgan H 2003 ldquoLeadership is a contact sport The ldquofollow up factorrdquo in
management development The 5th Annual Global Learning SummitResearched and
organised by SALVO 20ndash24Feb
Goldstein M2008Why measure service delivery Are you being serviced New tools for
measuring service deliveryEdited byAmin S Das Jamp Goldstein MWashington DCThe
International Bank for Reconstruction and DevelopmentThe World Bank
Griep RH Rotenberg L Chor D Toivanen SampLandsbergis P2010Beyond simple
approaches to studying the association between work characteristics and absenteeism
Combining the DCS and ERI modelsRoutledge Taylor amp Francis GroupWork ampStress 24 (2
April-June)179ndash195Available athttpwwwinformaworldcom (Accessed on 20072011)
Grogan J 2003 Workplace law 7 th edition Lansdowne Juta
Grogan J 2005 Dismissal discrimination and unfair labour practices Lansdowne Juta
Hirschfield RR Schmitt LPamp Bedeian GA2002 Job-content perceptions performance-
reward expectancies and absenteeism among low-wage public-sector clerical employees
Journal of Business and Psychology 16(4) Human Sciences Press Available on
rhirschfterryugaed(Accessed on 30032009)
Hoxsey D2010Are happy employees healthy employees Researching the effects of
employee engagement on absenteeismCanadian Public Administration53 (4) p551-
571Canada The Institute of Public Administration of Canada
Jacobs EJamp Roodt G 2011 The mediating effect of knowledge sharing between
organisational culture and turnover intentions of professional nursesSouth African Journal
of Information Management
Jankowitz E 1991Terminating for absenteeism practical labour management Rivonia IR
Data Publication 1(10)
Keese M2006 Live longer work longerDELSA Newsletter OECD Available at
httpwwwoecdorgelsemployment(Accessed on 10072011)
77
Lambert EG Camp SD Edwards Camp Saylor WG 2005 Here today gone tomorrow
back again the next day absenteeism and its antecedents among Federal Correctional
staffWashington DC Ohio
Landstad B Vinberg S Ivergard TT Gelin G ampEkholm J2001Change in pattern of
absenteeism as a result of workplace intervention for personnel support Ergonomics
001401391544 (1)
LexisNexis 2006Labour Law Reports July 1994ndashDec2006CumulativeIndex Durban
LexisNexis
LexisNexis 2007 Legislation and strategyLexisNexis (9)Durban Butterworths Available at
httpwwwmylexisnexiscoza (Accessed on 15072011)
Madibana LF 2010 Factors influencing absenteeism amongst professional nurses in
London Pretoria University of South Africa
Markussen S Rogeberg OJ amp Gaure S 2009 The anatomy of absenteeism IZA
Discussion Paper Series No 4240 June Bonn Institute for the Study of Labor
McCormick ET amp Ilgen D1985 Industrial and organizational psychology 8th edition New
Jersey Prentice-Hall
McGoldrick E amp Arrowsmith JJ 2001Discrimination by age the organizational response
Ageism in work and employment Edited by Glover IampMohamed Sterling Management
SeriesEngland University of Sterling
Mellor N Arnold Jamp Gelade G2009The effects of transformational leadership on
employees in four of UK public sector organisations Health and Safety Laboratory for the
Health and Safety Executive UK RR648 Research Report
MINTRAC 2009 Literature review on labour turnover and retention Available at
strategieswwwmintraccom (Accessed on 14042009)
Mouton J2005How to succeed in your Masterrsquos and Doctoral studies a South African guide
and resource book Pretoria Van Schaik
Munro L 2007 Absenteeism and presenteeism possible causes and solutions The South
African Radiographer45(1) Available onhttpsorsaorgza(Accessed on 10072011)
Nel PS Gerber PD Van Dyk PS Haasbroek GD Schultz HB Sono TampWerner A
2001 Human resource management5th edition New York Oxford
Nel PS Kirsten M Swanepoel BJ Erasmus BJampPoisant P 2008South African
employment relations theory and practice6th edition Pretoria Van Schaik
78
Nichols AampEvangelisti W2001 Fitness for work the effect of aging and the benefits of
exerciseSterling management series ageism in work and employmentEdited by Glover
LampMohamed B England University of Sterling
Nyathi MN 2000Factors contributing to absenteeism among nurses a management
perspective Pretoria University of South Africa
Patrick MN 2001Positive psychological functioning among civil servantsPretoria
University of South Africa
Paton N2010 Long-term absence hand in hand Occupational Health Reed Business
Information UK Reed Elsevier Available athttpebscohostcomoasisunisaacza
(Accessed on 10072011)
Parbhoo S2003 Why worry about absenteeism in the workplace CCMA PublicationCCMA
Mail July
Pierce K2009 The impact of absenteeism in the public service in the context of GEMS
Pretoria GEMS Government Employees Medical Scheme [lsquoslrsquo]
Public Service and Co-ordinating Bargaining Council (PSCBC) 2000Resolution 72000
Polit DF amp Hungler BP 1995 Nursing research principles and methods Philadelphia
Lippincott
Pousette A amp Hanse JJ 2002Job characteristics as predictors of ill-health and sickness
absenteeism in different occupational types-a multigroup structural equation modelling
approachNational Institute for working life TaylorampFrancisSweden Goteborg Available on
httpwwwtandfcouk (Accessed on 10072011)
Public Service Commission2002Sick leave trends in the Public Service Pretoria Public
Service Commission
QUALSA Report 2009Policy procedure incapacity leave and ill-health retirement Steering
Committee QUALSA [rsquoslrsquo]
Reday-Mulvey G 2005Working beyond 60 key policies and practices in Europe New York
Palgrave Macmillan
Republic of South Africa 1995 Labour Relations Act 66 of 1995
Republic of South Africa 1997 Basic Conditions of Employment Act 75 of 1997
Republic of South Africa 2001 Public Service Regulation 2001
79
Republic of South Africa 2011 ldquoTowardsquality care for the patientrdquo National Core
Standards for Health Establishments in South Africa Pretoria Government Printers
Robbins SP amp Decenzo DA 2001 Fundamentals of management essential concepts and
applicationsNew Jersey Prentice Hall
Robbins SP Odendaal A amp Roodt G2004Organizationalbehaviour Global Southern
perspective 5th impression Cape Town Pearson
Rogers RE amp Hertin SR 1993Patterns of absenteeism among government employees
Public Personnel Management22 (2)Available at httpwwwquestiacom (Accessed on
10012009)
Serneels P Lindelow MampLievens T2008Qualitative research to prepare quantitative
analysis absenteeism among health workers in two African countriesAre you being
serviced New tools for measuring service deliveryEdited by Amin S Das
JampGoldsteinM2008 The International Bank for Reconstruction and DevelopmentThe
World Bank for Reconstruction and Development Washington D C The World Bank
Slabbert JA amp Swanepoel BJ 2001Introduction to employment relations
managementDurban Butterworths
South African Survey Millennium1999-2000 Johannesburg South African Institute of Race
Relations
Steers RMamp Rhodes SR 1978Major influences on employee attendance a process
model Journal of Applied Psychology63 (4)391-407
Oi-ling S2002Experience before and throughout the nursing careerPredictors of job
satisfaction and absenteeism in two samples of Hong Kong nursesJournal of Advanced
Nursing 40 (2)218ndash229 Available on httpwwwebscohostcomoasisunisaacza
(Accessed on 10072011)
Todd C2001Contract of employment Claremont Siber Ink
Tonya TW2001Minimizing absenteeism in the workplace strategies for nurse managers
Nursing Economics19 (2 MarApril) 53 3 Available at httpwwwoasisunisaacza
(Accessed on 14012009)
Tustin C 1994Industrial relations a psychological approach1st edition Halfway House
Southern Publishers
80
Unruh Jamp Strickland M2007 Nurse absenteeism and workload Negative effect on
restraint use incident reports and mortality JANORIGINAL RESEARCH Journal compilation
Florida Blackwell
Van der Westhuizen C 2006Work related attitudes as predictors of employee absenteeism
Pretoria University of South Africa
Venter R 2003 Labour relations in South AfricaRevised edition Cape Town Oxford
University Press
Viviane IJ 2011Absenteeism among women workers in industry85 IntrsquoLab Rev 248
(1962) Available at httpwwwHeinonlineorg(Accessed on 18052012)
Weeks KL 2004 Development and initial characteristics of a comprehensive survey on
workplace absenteeism Logan Utah State University Available on
httpwwwoasiscomunisaacza(Accessed on 14012009)
Welman JC amp Kruger SJ2001Research methodology for the business and administrative
sciences 2nd edition New York Oxford
Yende PM 2005 Utilising employee assistance programmes to reduce absenteeism in the
workplace JohannesburgUniversity of Johannesburg
81
ANNEXURES A B C
ANNEXURE A
PROCESS EVALUATION QUESTION COMPLIANCE
YESNO
ACTION PLAN
Retention and Reward -
leave
1 Are there complete and
accurate Z 1(Leave application
forms) forms on file
2 Have all application forms been
approved stamped and
registered
3 Have all forms been captured
on the Persal with the following
requirements
Supporting documents
A 10 day compulsory leave
processed within the annual
leave cycle Determination of
Leave
4 The remaining days are utilized
6 months from the end of the
leave cycle
5 Are there unutilized leave days
6 Has there been adequate
checking of leave reasons
Leave credits
Adherence to leave categories
(i)Normal ( ii) Incapacity
(iii) Injury on duty (iv) Maternity
(v)Adoption (vi) Family
responsibility
(vii) Office bearersshop stewards
and Casual Employees
7 Have work reasons been
provided for leave days
(Source Compiled by C S Ndhlovu 2012)
82
ANNEXURE B
Retention and
reward ndashsick leave
Evaluation Question Compliance YesNo Action Plan
1 Are there medical
certificates that have been
submitted to all medical
claims with the following
Specific illness stated
Supporting documents on
file
2 Has the 8 week rule for
36 days in a 3 year cycle
been adhered to
3 Are there complete
medical certificates for 3
days or more sick leave
days for normal sick leave
4 Are all other leave days
above 3 days utilized after
36 days treated as
temporary incapacity
leave
5 Are temporary
incapacity leave forms
submitted within 5 working
days after the first day of
absence
6Is there a register for
temporary incapacity
leave for 1 to 29 days lead
time for reporting leave
applications
7 Has the employer
approveddeclined the
leave application within 30
working days of receipt
(Source Compiled by C S Ndhlovu 2012)
83
ANNEXURE C
CHECK LIST
Is there a leave register in place for all leave applications
1 Is leave approved prior to the employee proceeding on leave
2 Area attendance registers maintained and up to date
3 Are periodic audits for leave carried out
4 Is there evidence of GSSCrsquos approval on leave applications
5 Are leave forms accurately captured on Persal
6 Are leave forms accurately completed by applicants
7 Is movement of leave forms monitored between the GSSC and institutions
8 How is rejected leave application dealt with
(Source Compiled by C S Ndhlovu 2012)
84
Table of Contents
1 CHAPTER 1 GENERAL INTRODUCTION 1
11 INTRODUCTION 1
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH 1
13 PROBLEM STATEMENT 2
14 AIM AND OBJECTIVES OF THE RESEARCH 2
141 Aim 2
142 Objectives 2
15 LITERATURE REVIEW 3
16 TERMINOLOGY 3
17 RESEARCH DESIGN AND METHODOLOGY 4
171 Research design 4
172 Methodology 5
173 Unit of analysis 7
174 Unit of observation 7
18 CONSTRUCT VALIDITY 7
19 ETHICAL CONSIDERATION 7
110 LIMITATIONS OF THE RESEARCH 8
111 STRUCTURE OF THE RESEARCH 8
112 REFERENCE TECHNIQUEhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip9
113 CONCLUSION 9
2 CHAPTER 2 MANAGING ABSENTEEISM 10
21 INTRODUCTION 10
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM 10
221 Classification of absenteeism 15
222 Definition of key concepts 15
23 EMPLOYMENT RELATIONSHIPS 17
231 Employment relationship as a multi-dimensional phenomenon 17
2311 Economic dimensions 17
2312 Legal dimension 18
2313 Individual dimension 18
2314 Collective dimension 19
2315 Psycho-social dimension 19
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM 19
25 PREDICTORS OF ABSENTEEISM 20
26 A MULTI-GROUP INVARIANCE MODEL 22
27 CATASTROPHIC MODEL (CAT) 24
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM 24
VI
281 Measuring absenteeism 25
29 IMPACT OF WORKPLACE ABSENTEEISM 25
291 Cost to the institution 26
292 Low productivity 27
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM 27
2101 Effective communication 28
2102 Empowerment of managers 28
2103 Monitoring of workplace absenteeism 29
2104 Visits to facilities 30
2105 Incentive system 30
2106 Team support 31
2107 Return-to-work interviews 31
2108 Employee assistance programme (EAP) 32
2109 Occupational and safety committee 32
21010 Review committeehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip33
211 CONCLUSION 33
3 CHAPTER 3 METHODOLOGY IN RESEARCH 34
31 INTRODUCTION 34
32 RESEARCH DESIGN 34
321 Methodology 34
33 UNIT OF ANALYSIS 36
34 UNIT OF OBSERVATIONS 36
35 CONSTRUCT VALIDITY 36
36 ETHICAL CONSIDERATIONS 37
37 CONCLUSION 37
4 CHAPTER 4 INTERPRETATION AND ANALYSIS OF DATA 38
41 INTRODUCTION 38
42 THE STRUCTURE OF THE ORGANISATION 38
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY 39
44 COMPARISON OF HOSPITALS PERMANENT EMPLOYEES 40
441 The Tara Moross Centre Hospital 46
442 The Germiston Hospital 46
443 The ODI District Hospital 46
444 The George Mukhari Hospital 46
45 RESEARCH INTERPRETATION 47
451 Occupational groups in relation to absenteeism 49
4511 Doctors 50
4512 Professional nurses 51
4513 Staff nurses 51
VII
4514 Nursing assistants 51
4515 Finance officers 52
4516 Administration staff 52
4517 Administration support 52
452 Race in relation to absenteeism 57
4521 Africans 57
4522 Whites 57
4523 Coloureds 57
4524 Indians 58
453 Tenure range in relation to absenteeism 59
454 Salary range in relation to absenteeism 60
455 Age of full time employees in relation to absenteeism 61
456 Gender in relation to absenteeism 63
457 Week days in relation to occupational groups 64
46 CONCLUSION 66
5 CHAPTER 5 FINDINGS CONCLUSIONS AND RECOMMENDATIONS 67
51 INTRODUCTION 67
52 FINDINGS 67
53 CONCLUSIONS 71
54 RECOMMENDATIONS 72
BIBLIOGRAPHY 74
ANNEXURES A B Chelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip82
VIII
LIST OF FIGURES
FIGURE 21 CONCEPTUAL FRAMEWORK MODELhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
FIGURE 22 MODEL SPECIFICATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
FIGURE 41 INTEGRATED ORGANISATIONAL STRUCTUREhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip53
AS REPRESENTED BY THE HOSPITALS
FIGURE 44 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip58
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip60
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip61
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALShelliphelliphelliphelliphellip62
FIGURE 48 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip64
X
LIST OF TABLES
Table 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
Table 2 COMPARISONS OF NUMBERS OF ADMINISTRATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
AND SUPPORT STAFF IN THE DIFFERENT HOSPITALS
Table 3 GENDER COMPARISON IN DIFFERENT HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Table 4 COMPARISON OF TENURE OF SERVICE IN RELATION TOhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
ABSENTEEISM IN THE FOUR HOSPITALS
Table 5 COMPARISON OF THE OCCUPATIONAL GROUPShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip45
IN THE DIFFERENT HOSPITALS
Table 6 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip48
Table 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Table 8 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip54
(SALARY RANGE 1-12)
Table 9 AGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip55
Table 10 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Table 11 WEEK DAYS IN RELATION TO ABSENTEEISM INhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip65
THE FOUR HOSPITALS
Table 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphellip66
IX
CHAPTER 1
GENERAL INTRODUCTION
11 INTRODUCTION
The Gauteng Province is viewed as a province of opportunities by South Africans as well the
neighbouring countries such as Mozambique and Zimbabwe The impact of these
perceptions has placed a heavy demand on services including health provided within the
confines of the province the results being an increase in the workload of the employees
The indirect results of the increase in the workload have been unacceptably high levels of
absenteeism seemingly sub-standard levels of health care and high cost of delivering the
health care services Absenteeism poses a threat and can lead to the collapse of health care
services if absenteeism is poorly managed The research examines the management and
control of absenteeism in four out of thirty four hospitals that service the province The
hospitals that have been targeted for the research are ODI District Hospital Germiston
Hospital TARA Moross Centre Hospital and George Mukhari Hospital
This chapter explains the background and motivation for the research The research
highlights the problem statement which focuses on the effective management of
absenteeism The objectives of the study the research methodology and structure of the
research are explained The relevant literature review was consulted for the research The
key concepts that are used in the research are conceptually defined The research design is
a descriptive stratified random survey The data that were used were collected in three
phases the unit of analysis were the employees of the Gauteng Department of Health in the
four target hospitals and the unit of observations were observations of the employees of
the four hospitals The construct of validity was achieved through using a variety of data
collection methods Ethical considerations were taken into account during the research
process Limitations of the research were imposed by the uniqueness of each of the target
hospitals The structure of the research and the reference technique is explained in this
chapter The research on absenteeism in the Gauteng Department of Health is confined to
the period of 1 January 2008 to 31 December 2008 and focused on the working-man days
lost how absenteeism is managed and employee well-being and rehabilitation
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH
The Gauteng Department of Health received a qualified report in 2008 on the control of sick
leave A performance audit was conducted by the Public Service Commission (PSC) (2002
xvi) into the information required to effectively manage sick leave in the public service
1
The research on absenteeism in Gauteng Department of Health seeks to examine the extent
of workplace absenteeism in the ODI District Hospital which is in a transitional stage from
North West to the Gauteng Province The hospital falls under Tshwane Metropolitan
Municipality and is in Region C The Germiston Hospital falls under Ekurhuleni Metropolitan
Municipality in Region B TARA Moross Centre Hospital is in Region A under the
Johannesburg Metropolitan Municipality and George Mukhari Academic Hospital is Region C
under the Tshwane Metropolitan Municipality The research seeks to examine the degree of
compliance by the four hospitals with the recommendations of the performance audit of
management of sick leave in the light of the qualified report received by the Gauteng
Department of Health (Human Resources) in 20089
13 PROBLEM STATEMENT
The Gauteng Department of Health provides health care services as the core business of the
Department The Health care services are labour intensive and high levels of absenteeism by
its employees undermine the Departmental efforts to deliver quality health care to the
people of Gauteng The problem statement therefore is to examine to what extent the
effective management of absenteeism can enhance the effectiveness of the Gauteng
Department of Health
14 AIM AND OBJECTIVES OF THE RESEARCH
The aim and objectives of the research are explained in this section
141 AIM
The aim of the research is to determine how the effective management of absenteeism can
contribute to the effective health care of Gautengrsquos communities
142 Objectives
The objectives of the study are
to determine the impact of the variables such as age gender occupational category
and salary level on workplace absenteeism
to determine whether the correlation between absenteeism levels and tenure of
service does exist
to determine trends of workplace absenteeism in different employee categories and
to establish the different challenges confronting the different hospitals in
management and control of absenteeism in terms of size complexity and location
2
15 LITERATURE REVIEW
Various studies have been conducted to examine workplace absenteeism in different fields
in government and private institutions Van Der Westhuizen (200636) research focused on
high and low combinations of job involvement and organisational commitment The
outcome was not emphatic on the findings as predictors of the turnover and absenteeism
The research noted that women are more absent from the workplace than men De Wit
(2006) focused on the nature of absenteeism the impact of absenteeism on the
organisation reasons for and causes of absenteeism and measurement of absenteeism and
the findings were not able to find a high coefficient in the test sample
Camp and Lambert (20054) found that the use of sick leave as an incentive to reduce sick
leave by the employees under the Civil Service Retirement System (CSRS) led to a reduction
of absenteeism as a result of sick leave when compared with employees who functioned
under the conditions of the Federal Employees Retirement System (FERS) who within the
same company lost the unused sick leave when they retired
Ferguson Ferguson Muedder and Fitzgerald (200138) focused on the impact of
absenteeism and cost in terms of time lost in the Total Absence Management (TAM)
concept and found that the aging employee exposes institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods of
time
Serneels Lindelow and Lievens (2008210) claim absenteeism is high among employees in
the public sector in developing countries due to a lack of accountability and a lack of
punishment for transgression
The research seeks to determine the extent of the problem of workplace absenteeism its
impact and management in the identified hospitals It seeks to establish the relationship if
any between the various variables and absenteeism such as age occupation tenure salary
level gender and race
16 TERMINOLOGY
Key concepts that are used in the research are conceptually defined however a
comprehensive concept clarification will be done in chapter 2
Workplace absenteeism Workplace absenteeism is the absence of employee at the
workplace that is defined by Du Toit and Van Der Waldt in (1998139) as the place that the
institution makes available and where officials have to perform their work
3
Workplace forms part of the internal environment for public administration in the public
service Robbins Odendaal and Roodt (200415) define absenteeism as the failure of an
employee to report for work as scheduled regardless of the reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work According to
Venter (2003267) desertion occurs when the employee leaves the place of employment
without the intention to return to work
Employee An employee is defined as any person employed in terms of the Public Service
Act 1994 irrespective of rank or position (Public Service Act 1994 Subsection 15) Todd
(20011) refers to an employee as any person excluding an independent contractor who
works for another person and is entitled to be paid for it or who in any manner assists in
carrying on or conduct the business of the employer Bendix (2000123) defines an
employee as a person in a workplace except a ldquosenior managerial employeerdquo whose status
and contract of service grants the employee the authority to represent the employer in
interactions with the workplace forum to determine policy on behalf of the employer and
make decisions which might conflict with representation of workers at the workplace
Employer An employer as an individual person who may be the employer in legal terms as
well as the organisation which is responsible for implementing Public Service human
resource management policies (RSA 1997 Section 15)
Leave cycle The Public Service Act 1994 refers to the leave cycle as 36 months employment
with the same employer
Quality Is defined as getting the best results possible within the available resources (RSA
2011)
Standard Is a statement of an expected level of quality delivery A standard reflects the
ideal performance level of a health establishment in providing quality care (RSA 2011)
17 RESEARCH DESIGN AND METHODOLOGY
This section deals with the research design and methodology
171 Research design
Research design is the overall plan for relating the conceptual problem to relevant empirical
research It is a quantitative descriptive research that involves the systematic collection of
numerical information under conditions of considerable control (Polit amp Hungler 1994
24175)
4
The choice of the research design influences subsequent research activities such as
identifying the target subjects what data to collect and how they should be collected The
research design is a descriptive stratified random survey which is concerned with
characteristics of a specific population subject at a fixed point in time for comparative
purposes The focus is on a representative sample of the relevant population It is concerned
with the accuracy of the findings and their generalisability The survey is used to gain deeper
insight of the behaviour of employees with regards to motivation satisfaction and
grievances (Babbie 199289 Ghauri Gronhaug amp Kristianslund 199527 60 Brink 199611
6 Welman Kruger amp Mitchell 200152)
172 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services Four hospitals of the thirty four health care delivery institutions have been
identified for the research
Each hospital is unique in its character in terms of specialisation of health care delivery
service The four hospitals are located in Tshwane Johannesburg and Ekurhuleni
Metropolitan Municipalities The sample is a stratified random sampling which is composed
of various clearly recognisable non-overlapping sub-populations (strata) that differ from
one another mutually in terms of variables that are a combination of more than one
variable such as age sex income level or educational level The purpose is to ensure that
every part of the population (every stratum) is represented The members of a particular
stratum are homogeneous in the population at large The sample is representative of a
population with clearly distinguishable strata with a greater degree of certainty (Babbie
199267 Brynard amp Hanekom 200544 Ghauri et al 199578 Brink 1996138 Welman amp
Kruger 200155-56 Welman et al 201061 Polit and Hungler 199518) The data were
collected in three phases
The first phase of data collection was done through auditing of hard copies of identified
personnel files representing ten files per hospital and using the tool in annexure A amp B The
forty employeesrsquo profiles were accessed through the Human Resource Information
Management system (HRIM) located in the Gauteng Department of Health Head Office The
respective employeesrsquo profiles were handed over to the human resource manager in the
respective hospitals on the morning of the audit for the human resource practitioner to
draw out the hard copy files for auditing The characteristics of the individuals that were
identified for the first phase were males and females and the different race groups The
auditing of the files was for the complete working life of the employees and not confined to
2008 only Registers that are used by the human resource administration to control the
movement of the leave forms were inspected as evidence of the control system in place
5
The purpose of auditing the files is to gain insight into how leave in general was captured
managed and controlled by the hospitals The second phase of data collection was done
through structured interviews with the four human resource managers who were directly
accountable for management and control of leave of absence in general in the four
hospitals
A structured interview provides for a more organised approach and a more stable basis for
assessment of the different candidates (Erasmus Swanepoel Schenk Van der Westhuizen amp
Wessels 2005250) The structured interview was conducted using the tool in annexure C
Tara Moross Centre Hospital had been functioning without a manager in human resource
and the manager that was interviewed had been in the post for three months The human
resource practitioner who was at salary level 8 acting in the Assistant Directorrsquos post
(manager) was invited to join the manager and be part of the structured interview ODI
District Hospital had three human resource practitioners including the accounting officer at
level 8 and in an acting capacity
The third phase of data collection was through the Human Resource Information
Management (HRIM) This system used Personnel Remuneration Administration System
(PERSAL) to collect data Data in this system are categorised in salary level date of
appointment occupational category gender age in units of five race employing hospital
employment status in different categories such as session contract and full-time and the
different types of leave of absence
The research used primary and secondary data in analysing sick leave utilised by full time
employees in the identified hospitals for the period of 1 January to 31 December 2008 using
the Personnel Remuneration Administration System The total population sample was four
thousands and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range at level 1 to 12
The research used past events such as sick leave utilised by employees using secondary
data from Personnel Remuneration Administration System falling into the category of a
historical empirical research The interval scale of measurement was used in the
quantitative research and actual numbers are ordered with equal measurement between
each category (Brink 1996 149 Brynard amp Hanekom 2005 28-29 Mouton 2005
52100170)
6
173 Unit of analysis
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the research refers to observation of work attendance by
the employees of Gauteng Department of Health in the four hospitals
The observation deals with the historical events such as employees who have already
utilised sick leave in the workplace The subjects that are studied are the core health care
providers such as doctors nurses and support employees such as allied administration and
administration support (Mouton 200551-52 Welman et al 2001 52-53)
174 Unit of observations
The observations that are made are of health care workers and support teams in Tara
Hospital Germiston Hospital ODI Hospital and George Mukhari Hospitals The unit of
observations describes the characteristics of a large number of individual people such as
gender age salary range occupational category tenure of service and race in relation to
absenteeism in the workplace In the descriptive research the individual characteristics are
aggregated for the purpose of describing a larger group (Babbie 199292)
18 CONSTRUCT VALIDITY
Construct validity is concerned with the question what construct is the instrument actually
measuring(Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with the four accounting officers in leave management The third phase was collecting of
personnel data through the Persal system
19 ETHICAL CONSIDERATIONS
Ethical considerations included among other issues the protection of the unit of analysis and
unit of observations from discomfort and harm by not revealing information which can
cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity Anonymity is achieved
when the researcher cannot link a given response with a given respondent and reporting
aggregate data only When data are collected at one sitting and not over a period of time
makes it possible to achieve anonymity as the need for follow up is eliminated Subjects of
observations are selected for reasons directly related to the problem being studied as the
principle of justice
7
Confidentiality is about the researcherrsquos responsibility to protect all data gathered within
the scope of the research and shared only with people involved in the research (Babbie
1992465ndash466 Brink 199640ndash41 45)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous The interview was part of the actual audit
that was done as part of monitoring and evaluation that was in progress in the Department
of Health following a negative auditor generalrsquos report about management of leave in
general The managers were put at ease as they were given the check list afterwards for
self-monitoring for future self-auditing
The data that were collected through Personnel Remuneration Administration System
(Persal) identified employees through the Persal number and kept their identity anonymous
The data that were collected through the hard copy of employeesrsquo files were used to point
out areas of concern to the managers and the files did not leave the office of the manager
at the end of the process once more protecting the identity of the employee
110 LIMITATIONS OF THE RESEARCH
The research was conducted on four hospitals of different sizes specialisation and three
metropolitans with unique challenges The period of the research was confined to a
calendar year (2008) and not a financial year The focus was on absenteeism due to sick
leave of full time employees There is no distinction that is drawn between the working-man
days that are lost between shift and non-shift workers The findings may be different if all
absenteeism of employees at the time were considered for the research
111 STRUCTURE OF THE RESEARCH
Chapter 1 It provides a general introduction to the research It includes an introduction the
background and motivation for the research that provides the context the problem
statement and the significance of the research The key concepts are defined The research
design the method of data collection the sampling method data analysis and
interpretation limitations to the research are explained in this chapter
Chapter 2 This chapter considers the theoretical foundations concepts characteristics
theories approaches and classifications of workplace absenteeism Conceptual framework
of absenteeism predictors of absenteeism and various models of absenteeism are
explained Measures to control workplace absenteeism the impact of absenteeism in the
institution and management intervention strategies are explained
Chapter 3 It describes the research design different aspects of the research methods
applied and the data collection techniques used unit of analysis units of observations
construct validity and ethical considerations
8
Chapter 4 This chapter provides the organisational structure of the Gauteng Department of
Health comparisons of hospital employees different race groups of the four hospitals
gender comparisons in different hospitals and comparisons of the different occupational
groups It provides a short description of the target hospitals The research interpretation is
discussed in terms of the different occupational groups and absenteeism different races
and absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism
The week days absenteeism pattern and contributions by the four hospitals to absenteeism
are presented in this chapter
Chapter 5 It provides a discussion of the research evaluation of workplace absenteeism
findings recommendations and limitations
112 REFERENCE TECHNIQUE
The reference technique that is applied in the research involves all sources that have been
consulted while doing the research When legislation is used as a source of information
reference to the specific act is used
113 CONCLUSION
Chapter 1 provides a discussion on the background and motivation of the research problem
statement and the objectives The significance of the research in South African public
institutions and private institutions of other countries and the possible contribution of the
study are explored The terminology that is used in the research is contextualised for the
purpose of the research The research design and methodology are presented in this
chapter The units of analysis the units of observation construct validity ethical
considerations and limitations to the research are also presented in this chapter
The next chapter discusses the theories of absenteeism
9
CHAPTER 2
MANAGING ABSENTEEISM
21 INTRODUCTION
The Gauteng Department of Health is classified as a public institution whose existence is
justified on the grounds that it renders health care services to the public The health care
system is encouraged to develop delivery systems and practices that are in line with
international standards management practices that promote efficient and compassionate
delivery of services and ensures respect for human rights and accountability to the public
(African National Congress 199443-44) This objective can only be achieved if the resources
to provide such services are available The human resources are a vital factor for the health
care sector as it is labour intensive Public institutions such as the Gauteng Department of
Health are funded from public funds and if the human resources do not report for work
service delivery is compromised and the cost to the department in the form of salary
expenditure becomes exorbitant as the department must find replacement staff and pay
for overtime as well It is when all these factors are taken into consideration that workplace
absenteeism becomes a cause for concern for the Gauteng Department of Health
In this chapter absenteeism is discussed from a theoretical perspective and informed by
literature review The classification of workplace absenteeism theoretical perspective
definitions dimensions of employment relationship conceptual framework of absenteeism
structural model of absenteeism legislative framework that regulates the employment
relationship and intervention strategies to control workplace absenteeism are explored
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM
According to Viviane (20111) the term absenteeism was first used in Britain during the
First World War in dealing with employed persons It is during the times when production is
of pressing national importance that the absence of employees from the workplace is keenly
felt Absenteeism is considered a good barometer of staff morale an indirect measure of
employeesrsquo health and well-being and is found to be associated with health-related
absences from work Employees who are motivated and committed to their work and
employer have to be very sick before they book off sick (Griep Rotenberg Chor Toivanen amp
Landsbergis 2010179)
McCormick and Ilgen (198556-57) describe job attendance criteria as relating to a tendency
of employees to withdraw from or attend to their jobs The criteria identified were job
tenure occupational category absenteeism and tardiness According to Markussen
Rogeberg and Gaure (20096) employee characteristics such as age gender education and
occupation have a substantial impact on absence behaviour
10
Chaudhury and Hammer (20033) identified that medical skills and nursing skills are
marketable and greatly in demand Doctors and nurses used this opportunity to make
money and work as private health care providers as well as public health care providers
holding two jobs The absence is considered in terms of morning or afternoon absence by
these categories as they are viewed as having a great deal of discretion over where and
when to discharge their public responsibilities The criteria identified were job tenure
absenteeism and tardiness
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) refer to absenteeism
as non-attendance when an employee is scheduled to work The theoretical perspective of
absenteeism takes into account the physical and or psychological absence of the employee
from the workplace or work station at a time when the employee is contractually expected
to be at the workplace According to Andrews (199734-35) the behaviour and actions of
public officials are determined by specific ethical codes of conduct and it is assumed that
their actions are for the benefit of the communities that are serviced by the public officials
Social ethics focus on how the clients of the Department are treated and are therefore
concerned with the impact of decisions on people inside and outside the institution
individually and collectively
Grogan (2005237) states that employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
look for trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
2001 section F(c) In the public sector contractual employee benefits are modified by
collective agreements These benefits are material gains for the employees and have a
monetary value and a cost factor to the employer
The contract of employment often includes insured benefits such as incapacity ill health
and early retirement as the total package other than the remuneration for the time worked
as it is intended to attract retain and motivate employees (Breetzke 20091 Ferguson et al
200137 LexisNexis 2006670 LexisNexis 2007176 Markussen Rogeberg amp Gaure 20093
Tustin 199452) The policy on Determination on Leave of Absence requires a medical
certificate for sick leave of three or more days and for every sick leave day utilised when the
eight week rule has been transgressed (DPSA 2009 Section 14 subsection 147)
Political ideologies influence the work environment resulting in some areas being highly
unionised where unions are perceived to be capable of exerting control over the employer
and employee relations for the primary benefit of the employees
11
It is the work environment which is highly unionised that is characterised by high workplace
absenteeism (Andrews 199736 Breetzke 20091 Du Toit amp Van Der Waldt 1998170139
Tustin 199452) Allen (1984331) claims that union members might be absent more
frequently from the workplace than non-members because they face smaller penalties for
absenteeism According to Markussen et al (20095 21) workplace environments do have an
impact on absenteeism and are influenced by social interaction processes among
colleagues Absenteeism is affected by social norms Workplaces with high employee
turnover rate tend to have high absenteeism The turnover rate is defined on a quarterly
basis as Min (number of entries number of existing persons) divided by the number of
employees at the start of the quarter The Charted Institute of Personnel and Development
(CIPD) (200811) claim that the 2006 survey of absence management portrays the public
sector employees as less likely to be dismissed for reasons of workplace absenteeism A
report by the National Institute of Labour Studies (Tonya 20011) found the rate of
absenteeism increased among full-time employees from 2 4 to 25 within two years
The services that are provided by the Department of Health are divided into two distinct
categories Direct services are those services that are rendered to the clients who are
patients who receive medical treatment from the core employees usually referred to as line
functionaries Direct services can only become effective and efficient when supported by
the services of the support staff that provide indirect health care services When employees
do not present themselves for work when scheduled to work and do so on a regular basis
the situation becomes habitual absenteeism (Du Toit amp Van Der Waldt 199818) The
Gauteng Department of Healthrsquos core function is to provide health care services to the
people of Gauteng Province The provision of health care services is labour intensive and
requires large numbers of personnel for effective service delivery
The workplace which may be physical or virtual for the public service employees represent
the internal environment of the institution The employer who is represented by the
manager determines the workplace for employees
Rogers and Hertin (1993217) explain the Decision Model Theory as a conscious decision by
the employee to stay away from work or come to work based on which motivation is
stronger at that moment It is not based on the ability to come to work
Serneels et al (2008210) claim that absenteeism is rife in the public sector especially where
employees hold two jobs The actions of public officials in the performance of their duties
should be ethically justified as it impacts on the decisions of people within and without the
institution individually and collectively Tension and job insecurity in the workplace
manifests as absenteeism (Andrews 199733-137)
12
Frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased staff
morale and high cost to health care (Davey amp Cummings 2009312-313) It is suggested that
on average health care workers are likely to be absent from work as a result of illness or
injury rather than other occupations Dagmara (20002) states that absenteeism may be a
benchmark of what is happening in the hospital setting Absenteeism is defined as habitually
not coming to work when scheduled to It is an indicator of psychological medical or social
adjustment to work
Absenteeism is measured by frequency or duration of work-days missed Frequency
measures provide a reasonable index of voluntary absenteeism whereby each incidence or
episode of absence is counted regardless of the duration of absence It is defined as the
number of days absent over a given period of time Other measures used were total days
duration and percentage Duration measures provide an index of involuntary absenteeism
such as time lost index To assess absence duration the total number of days is tallied
regardless of the number of incidents (Davey amp Cummings 2009313) High workload is
identified as one of the factors that affect absenteeism rate among health care workers
(Oi-ling 20023)
Workplace absenteeism is costly for an institution in terms of lost working-man days hiring
of staff to close the shortage absent or sub-standard service delivery and poor quality of
services The total cost of employment risk approach is about the estimation of the possible
cost of any absent employee to an institution per hour The annual cost to the institutions
per employee is in terms of direct and indirect costs such as overtime low productivity and
a decline in morale among workers who are expected to cover for an absent employee
(Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
The public service employees enjoy security of tenure which may be a contributory factor
of absence from work without good cause This practice is fostered by the knowledge that
they cannot be easily dismissed from their jobs therefore have the belief it is right to stay
away from work Misuse of sick leave is considered to be an overriding problem in instances
where the employee does not uphold the standard of honesty and incorruptibility or these
values are not considered to be the corporate values and norms of the institution (Andrews
1997 221-222 MINTRAC 20093)
Bangali (20043-5) describes age function in the sociological theory as a natural
characteristic of human beings but also an integral aspect belonging to the structure of the
society The age definition in the labour market is influenced by the structural functionalism
The employees age is categorised in the workplace in terms of functions to be performed
be it physical or intellectual The age group of 35 years to 49 years old employees comprise
the largest age group in the labour market
13
The employees who are less than 20 years of age reflect the highest absenteeism rate while
employees above 50 years of age reflect a decrease in the absenteeism rate The
disadvantage of the older workers is that their disabilities last longer once they are injured
and are more likely to be absent as frequently and more likely to be injured than younger
workers Keese (20062) states that ageism is evident in the public service and describes the
age group 25 years to 49 years old as prime age Rogers and Hertin (1993219) found a
significant correlation between the use of sick leave and age Employees with advanced age
used comparatively more sick leave in comparison with the younger employees The
Canadian Nurses Association (20065) noted a reduction in workplace absenteeism rate
among nurses who are less than 45 years of age and an increase in the absenteeism rate
among nurses above 55 years of age
Camp and Lambert (20054) found that the use of sick leave retention as an incentive to
reduce use of sick leave by the employees under the Civil Service Retirement System (CSRS)
leads to a reduction of absenteeism as a result of sick leave compared to the Federal
Employees Retirement System (FERS) who within the same company lost the unused sick
leave when they retired The Employees Retirement System (FERS) applies the same
principle of handling sick leave as the Gauteng Department of Health in the sense that
unused sick leave is forfeited at the end of the three year cycle (DPSA 2009Section 14)
Unruh and Strickland (2007674) found that absenteeism from the workplace does
contribute to a vicious cycle of a negative work environment which leads to more
absenteeism and increased turnover Absenteeism has been found to be higher in
employees who are over 50 years of age and the phenomenon is attributed to age and
changing abilities that increase when work is performed on a full time basis Part-time
arrangements reduce absenteeism as well as the cost of paying for a senior employee even
if seniority is just in tenure Age has been linked to a negative turnover in an institution The
older employee is less likely to leave the organisation An institution is healthier for a spread
of ages Some organisations consider employees to be older in batches or cohorts of five
such as 40 years to 44 years up to 64 years (Nichols amp Evangelisti 2001285 McGoldrick amp
Arrowsmith 200184 MINTRAC 20093 Reday-Mulvey 200579-194)
MINTRAC (20094-8) states that gender moderates the age turnover relationship Women
are more likely to remain in their jobs the older they get than men do Turnover is
occasionally related or preceded by high workplace absenteeism The occupational category
is linked to skill levels and salary levels The lower skill employees are concentrated in the
lower skill occupations and easily replaceable
14
Hirschfield Schmitt and Bedeian (2002553) conducted a research on low-wage public
sector clerical employees and found that those employees who perceived limited
performance-reward expectancies were likely to be absent more often The link between
skilled employees and absenteeism suggested that employees may have utilised
absenteeism as a means of compensating for perceived workplace contributions not
extrinsically rewarded
According to Gaudine and Gregory (2010599) the Canadian Institute for Health Information
(2007) found that absenteeism was a problem among health care workers in comparison to
other employees in other sectors Unruh et al (2007673) found the combination of high
registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery Markussen et al (200921) claim that the type of occupation an
employee is engaged in has an impact on absenteeism
221 Classification of absenteeism
The employees of the Gauteng province and their attendance at work are the focal point of
the province in relation to service delivery that is customer focused Health care services are
labour intensive and require employees to be at work when scheduled to do so (Gauteng
Province 201015) Workplace absenteeism can present in different forms and levels as a
result of a combination of variables (Andrews 19975 Breetzke 20091) McCormick and
Ilgen (198557) and Davey and Cummings (2009313) classify absenteeism as voluntary
when the absence is based on the conscious decision by the health care giver to withhold
contractual services The absence is uncertified unauthorised and unexcused while
involuntary absenteeism occurs for reasons beyond the control of the health care giver
such as illness injury or family responsibility Employers are challenged with the task of
differentiating between the absence due to elective workplace absence and absence due to
illness incapacity The differentiation is based on whether the illness incapacity is validated
by a legitimate medical certificate in terms of the prescript of section 23 of the Basic
Conditions of Employment Act (BCEA) 75 of 1997 (RSA 1997)
222 Definition of key concepts
Concepts are defined for common understanding in the context of the study
Workplace absenteeism Workplace absenteeism is absence of the employee at the
workplace that is defined by Du Toit and Van Der Waldt (1998139) as the place that the
institution makes available and where officials have to perform their work It forms part of
the internal environment for public administration in the public service Bamford Klein and
Engelbrecht (199911) refer to absenteeism as employees taking time off that has not been
scheduled
15
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) claim that
absenteeism is non-attendance when an employee is scheduled to work The European
Foundation (199711) views absenteeism as temporary or permanent incapacity for work as
a result of sickness or infirmity According to Robbins Odendaal amp Roodt (200415)
absenteeism is a failure of an employee to report for work as scheduled regardless of the
reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work The employee
should actually intimate expressly or by implication the intention not to return to work
According to Venter (2003267) desertion occurs when the employee leaves the place of
employment without the intention to return to work
Employee The Basic Conditions of Employment Act no 75 of 1997 Section 1 (a) (RSA 1997)
and Todd (20011) refers to an employee as any person excluding an independent
contractor who works for another person and is entitled to be paid for it or who in any
manner assists in carrying on or conduct the business of the employer The courts use the
control test which identified employees on the basis that they were part of the employer
organisation Bendix (2000123) claims that an employee is a person in a workplace except a
senior managerial employee whose status and contract of service grants the employee the
authority to represent the employer in interactions with the workplace forum to determine
policy on behalf of the employer and make decisions which might conflict with
representation of employees at the workplace Du Toit Bosch Woolfrey Godfrey Rossouw
Christie Cooper Giles and Bosch (200368) state that an employee is a person who works
for a single employer in a permanent fulltime capacity is subject to the supervision of the
employer and receives regular monthly or weekly remuneration and is obliged during
working hours to place his or her productive capacity at the employerrsquos prescribed disposal
Employer
Bendix (2000129) defines an employer as any person except an independent contractor
working for another person or the State and who receives remuneration or any manner
assists in carrying out or conducting the business of an employer DPSA (PILIR) (20094)
states that an employer is the Head of Department or a designated office which will be
responsible for the handling and investigation of incapacity leave applications and ill- health
retirement applications
16
23 EMPLOYMENT RELATIONSHIPS
The employment relationship is about balancing the simultaneous convergent and divergent
interests of the employer and the employee in a regulated manner with the aim of getting
the work of the institution done According to Erasmus et al (2005442) an employment
relationship exists when an individual is employed by someone else to be available to work
for that person in exchange for some remuneration It is through this employment
relationship that reciprocal rights and obligations are created between the employer and
the employee The employment relationship is conflictual in nature (Andrews 199736) The
employees through this relationship are enabled to gain access to the rights and benefits
associated with their employment The Labour Relations Act no 66 of 1995 (RSA 1995)
regulates the management of the conflict in the employment relationship through dispute
resolution structures such as the Commission for Conciliation Mediation and Arbitration
(CCMA) Labour Court and Labour Appeal Court when internal processes fail to resolve the
conflict The employment relationship can be traditional or typical and terms and conditions
of service of employment are regulated by collective agreements This is a tacit
acknowledgement of the existence of a typical employment relation
231 Employment relationship as a multi-dimensional phenomenon
Industrial relations and human resource management are bound together by the
employment relationship through labour employer and industrial relation triangle The
employment relationship is characterised by various dimensions as is the case in a broader
society The dimensions are economic legal individual collective and psycho-social (Grogan
200347)
2311 Economic dimensions
The economic dimension arises through the provision of labour by the employee in the form
of skill knowledge energy abilities and productive time to the employer in exchange for
remuneration Barker (200779) states that a reduction in working hours increases the
hourly cost of production in a unit unless there is a commensurate increase in productivity
The economic dimension is highly regulated The contract of employment includes insured
benefits such as incapacity ill health and early retirement The tendering of services by the
employees is a prerequisite to the employeersquos right to claim remuneration (Grogan
200347) According to LexisNexis (2007176) and the Public Service Regulations 2001
Section E E1 the actual contractual benefits are modified by collective agreements in the
public service sector Employee benefits are material gains for employees that have
monetary value and are a cost factor to the employer The Public Service Regulation 2001
Section F (a) states that the Head of Department shall promote economic and efficient use
of resource to improve the functioning of the public service (RSA 2001)
17
According to Ferguson et al (200137) and Erasmus et al (2005380) employee benefits are
the total compensation package other than the pay for time worked offered to employees
either partially or completely funded by the employer contributions In 2006 about R19
billion was lost on account of absenteeism from sick leave (LexisNexis 2006670 Patrick
2001 17)
Employee benefits are intended to attract retain and motivate employees Some of the
benefits offered to employees are mandated by law such as minimum leave provision as
contained in the Basic Conditions of Employment Act 75 of 1997 and Resolution 72000 of
the Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
2312 Legal dimension
The Labour Relations Act 66 of 1995 Section 3 of Schedule 8 requires that while employees
should be protected from arbitrary action employers are entitled to satisfactory conduct
and work performance from their employees The legal framework provides for the
regulatory requirements for human resource management in the working environment
Grogan (200347) and Grogan (2005120) view the employment relationship as formalised
by a legally binding agreement which is the contract The contract is regulated by specific
laws and formal rules with all the inherent rights and responsibilities to the employer and
the employee In terms of the employment contract one of the responsibilities of the
employee is to render service to the employer at specified agreed upon time except where
the employer has authorised the absence of the employee from the workplace Employees
have a fundamental duty to render services and the employer has a right to expect the
employees to tender such services A basic element of the duty to render service is that the
employee must be at the workplace at the specified agreed upon times unless there is
adequate reason to be absent Bendix (2000120) states that a contract is subject to the
terms and conditions of collective agreements The contract is subject to automatic changes
whenever a new collective agreement is in place The contract and its inherent benefits are
breached by elective absence behaviour of the employee The legal dimension has an
impact on the individual dimension
2313 Individual dimension
The employee enters into a working contract with the employer on an individual basis The
contents of the contract are subject to the Basic Conditions of the Employment Act 75 of
1997 The terms and conditions of employment in the public service are subject to collective
bargaining and collective agreements which influence the employment contract in the
Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
18
The contract of employment is entered into between the employer and the employee under
the supervision of the employer and for remuneration purposes
2314 Collective dimension
According to Slabbert and Swanepoel (20017) the collective dimension of the employment
relationship refers to the organised group aspect of the employment relationship which is
between labour as a group and employers and or their representative public sector
institutions The collective dimension aspect of employment relationship pertains to
legislation relating to bargaining dispute resolution and industrial action
2315 Psycho-social dimension
The psycho-social dimension of the employment relationship represents the unexpressed
needs and expectations of the employer and employees It refers to behaviour in the public
sector institutions within the context of the collective dimension (Davey amp Cumming 2009
313 Erasmus et al (2005442) The Public Service Regulation 2001 Section B states that the
Head of Department shall determine the working time of employees and take into
consideration their personal circumstances which have a social dimension (RSA 2001)
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM
Davey and Cummings (2009322) amalgamated two theories to create a theoretical
framework with the premise that employee attendance is based on two factors the ability
to attend and motivation to attend The theoretical framework focuses on individual work
ethics demographics and from the work environment Some form of absenteeism may be
difficult to prove in a situation where the employer has two or more operational stations or
the employee occasionally operates from a virtual office The duty to render service is
breached by the employee when the employee is physically present and mentally absent as
would be the case of sleeping on duty Workplace absenteeism is multi-dimensional such as
changes in the work environment that overburden the coping mechanism As a result of this
approach a multi-dimensional framework of absenteeism clouds the causative factors of
absenteeism (Breetzke 20091 Patrick 200124 Tustin 199452)
19
FIGURE 21 CONCEPTUAL FRAMEWORK MODEL
(Adapted from Davey amp Cummings 2009320)
The conceptual model uses individual predictors of absenteeism such as age salary level
tenure race gender occupation educational level job satisfaction and organisational
commitment ability to attend and pressure to attend Organisational commitment is
described as having loyalty to the organisation identifying with its core values and
influences whether or not an employee feels it is appropriate to take unauthorised
unscheduled absences Group level absenteeism is not viewed as a predictor of individual
absenteeism (Davey amp Cummings 2009320 Lambert Camp Edward amp Saylor 20058-9)
25 PREDICTORS OF ABSENTEEISM
Oi-ling (20023-6) claims that in Hong Kong there were 47500 work days lost as a result of
employee sick leave in 1998 and suggests the examining of stress levels for nurses in
different cultures to enable a fuller understanding of the predictors of absenteeism as
different cultures accept some predictors and some reject the same reasons for illness
20
Personal characteristics
2Employee value Job
expectation
1Job situation scopejob level role
stress work amp group size leadership
style
4 Satisfaction
with job situation
3 Ability to attend Illness and accidents transport problems
6 Attendance motivation
7 Employee
attendance
5 Pressure to attend work
incentiveswork ethics
Education
salary
tenure age
gender race
Occupation
Lambert et al (20058) claim that organisational commitment job satisfaction job stress
health issues and personal characteristics correlate as regards employee absenteeism The
findings of the research by Van Der Westhuizen (2006136) focused on high and low
combination of job involvement and organisational commitment and the outcome was
emphatic on the turnover as predictor of absenteeism
According to Unruh and Strickland (2007674) absenteeism from the workplace contributes
to a vicious cycle of a negative work environment which leads to more absenteeism and
increased turnover McCormick and Ilgen (198556) describe turnover as dysfunctional
where an employee wishes to leave the institution and the employer prefers to retain the
individual and is functional where the employee wishes to leave the institution and the
employer accepts the termination of services by the employee
De Wit (2006) focused on attitudes towards job factors that had an influence on
absenteeism and was not able to find a high coefficient in the test sample McGoldrick and
Arrowsmith (20018) claim that an organisation is healthier for a spread of ages Ferguson et
al (200138) state that aging employees expose organisations to high levels of absenteeism
through higher probabilities of becoming disabled for longer periods
Oi-ling (20023-6) and Patrick (200124) found that gender and age among other predictors
of absenteeism have a significant influence on absenteeism Age was positively related to
well-being in managers and negatively related to absence frequency among hospital
employees Older employees were shown to have higher responsibility at work and utilised
minimal days for sick leave Female employees were observed to have utilised more
absences than males
Andrews (1997221-222) and MINTRAC (20093-8) state that gender moderates the age
turnover relationship Women are more likely to remain in their jobs the older they get than
men do Turnover is occasionally related or preceded by high workplace absenteeism The
occupational category is linked to skill levels and salary levels The lower skill employees are
concentrated in the lower skill occupations and easily replaceable Public service employees
enjoy security of tenure which maybe a contributory cause of absence from work without
good cause a practice that is encouraged by the knowledge that they cannot be easily
dismissed from their jobs therefore have the belief it is right to stay away from work
Rogers and Hertin (1993217-222) found a correlation between the use of sick leave and
age Employees with advanced age comparatively used more sick leave in comparison with
younger employees The level of education seems to have influenced the use of sick leave
where the lower level categories of employees were found to have a higher level of
absenteeism than higher educated individuals
21
Robbins et al (200447) state that married women employees have fewer absences and
undergo fewer job turnovers Rogers and Hertin (1993222) express tenure as work
experience in years that is viewed as a predictor of employee productivity where seniority
has been found to be inversely related to absenteeism in terms of frequency and total
number of work-man days lost The level of education was found to have an influence
where the lower category of employees was found to have higher levels of absenteeism
than higher educated employees Jacobs and Roodt (2011425) and Davey and Cummings
(2009320) state that an organisational culture in hospitals can contribute towards lower
turnover as the turnover rate is a predictor of absenteeism The process can be facilitated
by promoting knowledge sharing that can provide opportunities that may meet employee
expectations
Pousette and Hanse (2002229-231) suggest that theories that make predictions about
antecedents to ill health and sickness absence make the assumption that the relationships
are the same in different occupations Reduced job autonomy is suggested to be associated
with higher sickness absence The occupation specific model is used in order to identify the
variance in the patterns in terms of occupation-groups Davey and Cummings (2009320)
found that turnover was significantly related to absenteeism
Hirschfield et al (2002553) conducted a research on low-wage public sector clerical
employees and found that those employees who perceived limited performance-reward
expectancies were likely to be absent more often The link between skilled employees and
absenteeism suggested that employees may have utilised absenteeism as a means of
compensating for perceived workplace contributions not extrinsically rewarded Unruh et al
(2007674) found that absenteeism from the workplace does contribute to a vicious cycle of
a negative work environment which leads to more absenteeism and increased turnover
26 A MULTI-GROUP INVARIANCE MODEL
A multi-group invariance structural model represents different types of occupations such as
industrial blue-collar workers industrial collar workers elderly care workers and child
health care workers The focus of this model relates to the extent to which a model that is
assumed to include a general population also includes sub-populations such as different
occupational types The occupation specific model allows different relationships between
variables in different occupations The specific model approach allows for identification of
the most common reasons for absenteeism and early retirement in the workplace and was
successfully utilised in Sweden A common model proposes that absenteeism is a
behavioural response to dissatisfaction with the job (Pousette amp Hanse 2002230-244)
Nyathi (200059) found that professional nurses were absent from work because they
wanted to prolong their weekends
22
Davey and Cummings (2009313) argue that on average health care employees are more
likely to be absent from work as a result of illness or injury than other occupations Paton
(20104) acknowledges that line managers are the fundamental building blocks for reducing
absenteeism and must be provided with the tools to manage absence The absence rate at
3 is considered very high and must be vigorously and progressively managed
FIGURE 22 MODEL SPECIFICATION
(Adapted from Pousette amp Hanse 2002232)
Pousette and Hanse (2002232-245) make the assumption that low job autonomy and low
skill discretion deprive the employees of the opportunity to handle work obstacles and
regulate workload to a manageable level implying a negative relationship to workload has
an impact on absenteeism rate Patrick (200123-24) states that changes in the working
conditions overburden the coping mechanism Work-related stress can lead to deteriorating
physical and emotional well-being The work object is the distinguishing quality between
occupations in the different occupational groups whereby the blue-collar employee works
with things that are tangible such as materials and machines whereas the white-collar
employee is knowledge based employee who is working with data
23
Structural Model
W L Work load
I H Ill-Health
S A Sickness absenteeism
S D Skills discretion
(autonomy)
27 CATASTROPHIC MODEL (CAT)
According to Buschak Craven and Ledman (199628) the catastrophic model (CAT) caters for
major illness that keeps the employee away from work for extended periods of time This
model is similar to short and long term incapacity sick leave whereby the employee has
exhausted the normal sick leave of 36 days which is catered for by DPSA section 14 (RSA
2009)
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM
The general behaviour and actions of public officials are determined by specific ethical
codes of conduct and the unethical conduct results in effective administration and
unsatisfactory service delivery (Andrews 199733) Effective control of workplace
absenteeism requires an absenteeism policy to be in place management to establish the
magnitude and patterns of absenteeism and raise awareness about the consequences of
breaking these rules (Bamford Klein amp Engelbrecht 19992)
The Determination on Leave of Absence in the Public Service (DPSA 2009 section 14 141)
the Public Service Co-ordinating Bargaining Council Resolution (PSCBC 72000) Davey and
Cummings (2009313) and DPSA (PILIR) 2009 section 3 31 state that an employee is
entitled to 36 working days sick leave with full pay in a three year cycle with the same
employer Any unused leave credits shall lapse at the end of the three year cycle The
employee is expected to utilise and manage the normal leave circumspectly The employee
who chooses to utilise sick leave days must submit a medical certificate for every occasion
of three or more sick leave days utilised The medical certificate must be issued and signed
by a practitioner or persons who are registered with the Professional Councils established
by the Act of Parliament Incapacity leave is additional sick leave granted conditionally at the
employerrsquos discretion An employee who has exhausted the normal sick leave during the
prescribed sick leave cycle and who requires to be absent from work due to a temporary
incapacity may apply for temporary incapacity leave with full pay According to the Policy
and Procedures on Incapacity Leave for Ill-Health Retirement (PILIR) (DPSA 2009) an
employer is not required to pay an employee if the employee has been absent from work
for more than two consecutive days or more than two occasions during an eight week
period and on request does not produce a medical certificate
The Public Service Regulations 2001 F (c) holds the manager accountable when an
employee abuses sick leave (RSA 2001) According to Parbhoo (20036) and Nel et al
(2008145) the doctor patient confidentiality is not above reach to the employment
relationship by suggesting that the employer can question the authenticity or contents of
the medical certificate if there is sufficient reason to do so within the confines of
confidentiality
24
According to Breetzke (20092) South African employees are challenged by global trends to
seek mechanisms to deal with excessive absenteeism at the workplace The Charted
Institute of Personnel and Development (CIPD) (200811) claims that the 2006 survey
showed that public sector employees are less likely to be disciplined or dismissed for
reasons of workplace absenteeism
281 Measuring absenteeism
Measuring absenteeism in the workplace enables the employer to determine the extent and
nature of the problem Absenteeism is measured using two measures total time lost and
absence frequency Nel et al (2001584) In institutions total time lost is determined for
every group of employees and category of absence such as sick absence authorised and
unauthorised absence The recognised international norm is 3 Institutions challenged
whether to accept the international norm as the given or strive to bring workplace
absenteeism down in the interest of quality and quantity of service delivery The total time
lost index is calculated as the Total number of days lost due to absence over the period
multiplied by a thousand and divided by the average number of employees multiplied by a
thousand and divided by an average number of employees multiplied by total work-days
over the period (Amin Das amp Goldstein 20086 Breetzke 20094 Nel et al (2001584)
According to Nel et al (2001584) high workplace absenteeism rate is suggestive of incidence
that is of short duration and therefore more disruptive to the operational plans of an
institution as prior knowledge of pending workplace absenteeism allows for forward
planning and reduction of the costs associated with absenteeism The absence frequency
rate is calculated as Number of absence incidence over the period divided by the average
number of employees employed over the period (Breetzke 20094 Nel et al 2001254)
29 IMPACT OF WORKPLACE ABSENTEEISM
Lambert et al (20056 36) claim that absenteeism has adverse effects on those employees
who are good attenders as they are shuffled around to fill in the positions of absent
employees Organisations suffer the detrimental effects and consequences of employee
absenteeism Management expend valuable time to modify employee assignments to
respond to absences When employees who are in management or in highly specialised job
assignments report sick the work assigned to them remains undone because their positions
remain vacated and the work remains for them to complete The responsibility and
accountability these employees are entrusted with may influence less use of sick leave by
them
The White Paper on Transforming Public Service Delivery (DPSA 1997) holds management
responsible for the specific level of resources and for obtaining value for money in these
resources
25
Madibana (201022) found in the research about absenteeism amongst nurses that the high
rate of absence had an impact in the reduction of quality care rendered by nurses
291 Cost to the institution
Andrews (19978221) describes an institution as the process through which activities are
grouped logically into the distinct areas and assigned to managers It results in the logical
grouping of activities in a department Workplace absenteeism influences the cost of an
institution which influences the quality of the product or service that is rendered by the
institution Employee attendance is a vital element for managing productivity of any
institution and its individual members The unfilled posts reflect the absence of public
health care employees and do not absorb budget resources for salary and upkeep of
facilities Absent personnel still receive their salaries If public servants are not on the job
the expenditures embodied in them do not reach their beneficiaries (Chaudhury amp Hammer
20032 Lambert et al 20055) The cost is direct in terms of salary expenditure or indirect in
terms of staff replacement
Ferguson et al (200138) argue that the cost of employment risk approach is about
estimation of the possible cost of any absent employee to an institution per hour per day
Robbins Odendaal and Roodt (200415) estimate that absenteeism costs South African
institutions millions of rand a year in decreased efficiency and increased benefit payments
Fakie (20053) notes that sick leave costs the national government 15 of the total basic
salary expenditure for the National Department of Health from 1 January 2001 to December
31 2003
The South African Chamber of Business (SACOB) (Patrick 200117) acknowledges that in
2006 about R19 billion were lost on account of absenteeism resulting from sick leave
According to the European Foundation (19977) United Kingdom lost 11 billion pounds in
1994 Germany lost 30 5 billion EUC in 1993 and Belgium lost 24 billion EUC in 1995
Breetzke (20092) describes indirect costs as hidden costs harder to measure and may
include economic value of lost productivity Indirect costs relate to loss of production that
may arise by engaging some expects to provide service in the field where they are closing
the staff shortage gap Rogers and Hertin (19939) and the European Foundation (19978)
view the individual employee and his or her dependants in a social dimension aspect as
exposed to reduced income as a result of extended workplace absenteeism related to ill
health where long term incapacity is involved
The total cost of employment risk approach is about estimation of the possible cost of any
absent employee to an institution per hour The cost may be direct and indirect such as
overtime low productivity and a decline in morale among workers who are expected to
cover for an absent employee (Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
26
292 Low productivity
According to Jankowitz (19911) high levels of absenteeism are disruptive to production
where operators are interdependent or where levels of service have to be maintained
Buschak Craven and Ledman (199626) argue that absenteeism generates costs for the
institution and productivity problems put an unreasonable burden on the rest of the
employees who are at work An absent employee be it physical or psychological remains an
unproductive employee Absenteeism viewed from an employerrsquos perspective is regarded as
a problem that impacts negatively on service delivery while the employeesrsquo believe their
mere presence in the workplace is being productive
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM
Managing workplace absenteeism remains a challenge for all employers and the Gauteng
Department of Health has not been spared the challenges faced by other institutions as it
provides health care services to the citizens of Gauteng The provision of good quality health
care is vital for the development of human capital The implications of declining quantity
and quality of care is grave when the human capital equity and efficiency which are the
cornerstones of health care service delivery are threatened by employees who are not at
work when expected to be (Gauteng Province 200711) Misuse of sick leave is considered to
be an overriding problem in instances where the employee does not uphold the standard of
honesty and incorruptibility or these values are not considered to be the corporate values of
the institution (Andrews 1997 221-222 MINTRAC 20093)
According to Grogan (2005237) employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
identify trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
Part V Section F(c) (RSA 2001) The workplace can be a virtual office Workplace
absenteeism is perceived to be high in unionised workplace environments where unions are
perceived to be capable of exerting control over the employer and employee relations for
the primary benefit of the employees In the public sector contractual employee benefits
are modified by collective agreements
Public service managers are to focus towards results achievement and be accountable for
the performance of their institutions (Gauteng Province 201023) Workplace absenteeism
can be reduced by tightening up policies and procedures relating to control of absenteeism
and intensifying monitoring processes on absent employees
27
According to Cloete (2004290-297) public institutions are to provide quality goods and
services The public institutions require an appropriate infrastructure to enable them to
perform their core functions (Bamford et al 19991 Buschak et al 1996 28 Munro
200722)
2101 Effective communication
According to Oi-ling (200212) managers should alter the psycho-social environment at work
and cultivate an institutional climate that supports staff and facilitate effective
communication Institutions should raise awareness to employees of their rights and
responsibilities regarding leave of absence and the consequences of abusing it (Bamford et
al 19992) The policies should be clearly written and well communicated to all employees
and be readily available and accessible In a highly unionised environment these policies are
debated in bilateral or multi-lateral forums between management or employer
representatives and labour representatives The human resource practitioners must conduct
periodic in-house training on these policies for management and employees to facilitate
uniform interpretation and enforce compliance by all stakeholders The policies must be
couched in simple understandable language that is free of legal terms for ease of
comprehension by all users The policies on workplace absenteeism must be explicit of
actions to be taken when policies have been violated or employees are aggrieved
2102 Empowerment of managers
Workplace absenteeism is multi-dimensional requiring inputs from all related fields
Managers require on-going support and training on issues that relate to absenteeism at the
workplace The human resource unit works with managers to establish performance
standards training of employees on the importance of execution and assists managers to
focus on continuous improvements superior execution and employee empowerment
(Bergdahl 20019 RSA 2011)
The labour relations unit supports the training of managers on grievance handling bilateral
and multi-lateral encounters with employee representatives with employee education
issues specific to workplace absenteeism The Charted Institute of Personnel and
Development (CIPD) (200835) reported that 70 of managers in the public service have
been trained in workplace absenteeism handling
Employment relationships bind human resource and industrial relations together with the
common objective of achieving institutional goals and labour peace Managers focus on
managing the institution for productivity at the lowest possible cost by providing quality
care therefore reducing the risk of litigation control of absence from work and work
efficiency
28
It is the delays in dealing with issues that give the employees the feeling of being unfairly
treated and demoralised Consistency in upholding these processes is essential for creation
of a stable employment relationship while any deviation from the set processes give rise to
worker unfriendly environment (Bergdahl 20118-9)
2103 Monitoring of workplace absenteeism
The manager is expected to keep accurate records for all leave of absence taken by
employees In terms of the management of ill-health absencersquos the manager has to ensure
that the eight week rule is observed whereby the employee who has been absent from
work on more than two occasions during an eight- week period must regardless of the
duration of the sickness or injury submit a medical certificate (RSA Part V section F (b)
DPSA 2009 section 14 148) Pierce (200921) believes that management of human capital
may be achieved through the integration of employee benefits employee assistance
programmes and human capital
Monitoring of absenteeism is a human resource function that gets lost in the competing
functions that are carried out by human resource practitioners High levels of absenteeism
are an indication of poor management and or conflict within the employment relationship
The methods to monitor workplace absenteeism vary from one institution to the other It is
human resource management that establishes common guidelines that are used by
management to monitor workplace absenteeism In monitoring absenteeism the manager
considers each employeersquos case on its merit
The manager focuses on certain aspects of the case such as failure to call in on the day of
absence pattern of use of sick leave before or after holidays and sick absence occurring on
certain days of the week or month Monitoring systems to monitor and record attendance
of work are put in place to assist management with simple accurate functional data that
facilitates informed decision- taking at management level The employees of the province
and their attendance at work become the focal point of the province in relation to service
delivery Peer pressure monitoring comes from colleagues at the same facility Hierarchical
monitoring of employees by management may lead to more attendance for fear of being
discovered (Chaudhury amp Hammer 200319 Gauteng Province 201015) A health care
service institution may use Health Information System and Personnel and Salary
Administration System (PERSAL) among others to ease the burden of the monitoring
process All these tools combined are useful in gathering administrative data for
management
29
2104 Visits to facilities
The role of human resource at institutional level is to support and guide management as
well as monitor compliance issues Workplace absenteeism remains a key focus area
because of its impact on the budget of an organisation Unscheduled facility visits are
conducted with the view to audit workplace absenteeism The audit is to be done in line
with the auditor-general or internal risk managementrsquos approach to encourage consistency
A check list that is used is prepared by human resource practitioners and institutions are
familiar with A human resource accounting officer of the institution should be involved
when an audit is done
The institution must have evidence available of sporadic visits to employees who have been
identified as having developed absenteeism patterns with the view to rule out elective
absence The European Foundation (199713) and Munro (200722) state that ill- health is
the main reason for workplace absenteeism Employees who present with ill- health are
generally and frequently more absent from work than the healthy ones The authors also
observe that not all employee assistance programmes aimed at reducing workplace
absenteeism have an effect on the ill-health of the employees which render the
unscheduled visit to the employees vital to see where the caring employer could be of
assistance
2105 Incentive system
According to Buschak et al (199628) the catastrophic model (CAT) caters for major illness
that keeps the employee away from work for extended periods of time This model is similar
to short and long term incapacity sick leave which is catered for by PILIR subsection 73
(DPSA 2009) The managers require special training for successful implementation of the
policy The paid time off model (PTO) has hidden benefits incentives for employees not to
use unnecessary sick days which are then paid for at retirement The research by Lambert
and Camp (20054) compares the Civil Service Retirement System (CSRS) and the Federal
Employees Retirement System (FERS) and showed that in the final analysis and when
novelty wore off workplace absenteeism was not necessarily reduced by the incentive
system
Management should use the strategy to raise awareness about responsible utilisation of sick
leave through workshops about PILIR and the eight week rule It should show the benefits
of good sick leave management when employees are challenged with temporary or
permanent incapacity leave
The use it or lose it approach of the current system reward the abuse of sick leave as it is
viewed as not being beneficial by the employees to act responsible towards the use of sick
leave There is no deterrent not to abuse sick leave in the public sector
30
2106 Team support
Institutions value team effort over individual achievement Operational competencies are
viewed as essential Managers encourage effective communication among team members
motivating others and the development of problem-solving skills Managers through the
team development effort encourage nurturing and transmitting of the institutional culture
Institutional culture refers to a system of shared meaning within an organisation that
determines how employees behave in the workplace Culture and people are like glue that
ensures that institutional standards are upheld Individuals become units that form the
team and conversations at work are encouraged to strengthen team work knowledge
transfer and productivity (Bergdahl 20018-10 Goldsmith amp Morgan 200378 Robbins amp
Decenzo 2001174)
2107 Return-to-work interviews
According to Paton (20101ndash5) a phased return-to-work data management and remote
services are among the approaches employers may use to manage workplace absenteeism
The intervention can involve use of Information Technology systems and telephone
discussions Good absence management is about good people management The return-to-
work interviews provide management with the opportunity to get to know the employee
better and for the employee to substantiate his or her case The employee is afforded
privacy during the sessions which should happen as soon as the employee comes back to
work The key success in this strategy is unthreatening follow ups that are done A multi-
faceted approach is used to get people back to work such as phoning maintaining regular
contact and taking medical advice
The Charted Institute of Personnel Development Annual Report (200835) reported 90 of
public services that use the strategy and 77 use the risk assessment to aid return- to-
work The manager should have private counselling sessions with the employee as soon as
the employee returns to work These sessions provide the employee with the opportunity to
put his or her case across and for the employer to get a first-hand opportunity to asses if the
employee is fit enough to come back to work The employer has to make the employee
aware of the status of the meeting that it is formal and proceedings are recorded The
employer is to keep accurate records of all counselling sessions
31
2108 Employee assistance programme (EAP)
DPSA (PILIR2009) prescribes that the PILIR committee promotes EAP in the workplace and
each institution to establish a committee The PILIR committee consists of a labour relations
officer an EAP practitioner a health practitioner an employee wellness practitioner and
any other relevant practitioner who is co-opted on a needs basis The purpose of the
committee is to manage short and long term incapacity which is sick leave utilised after the
employee has exhausted the 36 days normal sick leave in a three year cycle The short term
incapacity sick leave is of longer than three days and less than 29 days and long term
incapacity is sick leave longer than 29 days The short spells of sick leave become a concern
when there is evidence of a pattern of abuse It is a call for the manager to intervene Every
organisation should provide EAP that is funded by the employer to the employees A health
risk manager is used by the employees who are expected to honour referrals and stay with
the programme until such time that there is evidence of recovery failure by the employee
to accept the programme should attract a disciplinary process
According to Mellor Arnold and Gelade (20098) the amount of support that followers
receive from their transformational leader or co-worker may help reduce levels of absence
by making the workplace a more pleasant place to be and perhaps by helping the person
find solutions to work out family conflict or other problems that produce absence Landstad
et al (20011) suggest that the individuals in the preventive intervention group who were
less than 42 years of age total absence due to sickness decreased The change was obvious
to the cleaners who had a previous history of high absence due to sickness The Charted
Institute of Personnel Development (200836) focused on working-man days lost
management of absenteeism employee well-being and employee rehabilitation The skilled
employees were reported as 12 who were using rehabilitation programmes Yende
(200535) and Fakie (200517) state that EAP despite having been around since 1996 for the
National Department of Health has not actually been managed and utilised to its full extent
whereby if fully utilised would assist in the management of employee workplace
absenteeism
2109 Occupational and safety committee
The focus of this committee is on the provision of a safe working environment by the
employer (RSA Part VI section D 2001) It monitors issues of compliance and adopts the
employee advocacy role The committee consists of all the major stakeholders such as
employee representatives labour representatives that represent employees in the
institution on issues of safety at the workplace In the context of the Gauteng Department
of Health the committee engages with the labour representatives and employer
representatives at bilateral and provincial multi-lateral scheduled meetings
32
According to Du Toit and Van Der Waldt (1998139) the International Labour Organisation
recommends creation and maintaining of a pleasant work environment in order to improve
productivity The environment must stimulate the employee to ensure efficiency and
effectiveness
21010 Review committee
This structure is essential when dealing with incapacity leave It is composed of
management human resource practitioner employee representative labour relations
officer employee wellness and any adhoc person needed in terms of the case under
discussion (DPSA PILIR 2009) The employee reserves the right to lodge a grievance about
the outcome of his incapacity request if it is negative The role of the committee is to
provide a transparent forum reduce hostility against management and to protect the rights
of the employee through involvement of the employee representative
211 CONCLUSION
The literature review that has been consulted explores the workplace absenteeism and its
impact on the institution The employment relationships represent a triangle that consists of
the employer the employee and the industrial environment The relationship is multi-
dimensional and highly regulated with built in mechanisms to handle conflict in the
workplace Conflict is inherent to the employment relationship and structures and
mechanisms such as bargaining councils the Commission for Conciliation Mediation and
Arbitration and Labour Courts are structures for recourse The theory of absenteeism and
employment relationship were explored Management intervention strategies were
explained Controlling absenteeism in the workplace begins with a sound absenteeism
policy that is incorporated into an employee induction programme Communicating and
educating the employees about the absenteeism policy takes the centre stage in the
employment relationship Vigilant monitoring of workplace absenteeism is the responsibility
of the manager closest to the employee such as the supervisor Workplace attendance
problems of employees can be handled using sound judgement keeping accurate
attendance records and administering the policy fairly and consistently
Chapter 3 will collect data which will confirm or negate the literature review that has been
explored in chapter 2
33
CHAPTER 3
METHODOLOGY OF THE RESEARCH
31 INTRODUCTION
Chapter 3 focuses on the methodology used to determine the absenteeism in the four
hospitals of the Gauteng Department of Health The research design and the methodology
that have been used to collect data are discussed below The data are collected in terms of
the characteristics of the stratified random sample such as absenteeism of the different
occupational categories gender age tenure of service race groups and salary
32 RESEARCH DESIGN
A research design is the overall plan for relating the conceptual problem to relevant
empirical research It is a quantitative descriptive research that involves the systematic
collection of numerical information under conditions of considerable control The choice of
the research design influences subsequent research activities such as identifying the target
subjects what data to collect and how they should be collected The research design is a
descriptive survey which is concerned with characteristics of a specific population subject at
a fixed point in time for comparative purposes The focus is on a representative sample of
the relevant population It is concerned with the accuracy of the findings and their
generalisability The survey is used to understand the behaviour of employees with regards
to motivation satisfaction and grievances (Babbie 1992 89 Ghauri et al 199527 60 Brink
199611 Welman et al 200152)
321 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services The four hospitals that have been targeted for the study of absenteeism are Tara
Moross Centre Hospital in Region A under the Johannesburg Metropolitan Municipality
Germiston Regional Hospital which is in Region B under Ekurhuleni Metropolitan
Municipality ODI District Hospital in Region C under Tshwane Metropolitan Municipality
and George Mukhari Academic Hospital in Region C under Tshwane Metropolitan
Municipality Each hospital is unique in its character in terms of specialisation of health care
delivery service The sample is a stratified random sampling which is composed of various
clearly recognisable non-overlapping sub-populations (strata) that differ from one another
in terms of variables that are a combination of more than one variable such as age sex
income level or educational level The purpose is to ensure that every part of the population
(every stratum) is represented The members of a particular stratum are homogeneous with
the population at large
34
The sample is representative of a population with clearly distinguishable strata with a
greater degree of certainty (Babbie 19927 Brink 1996138 Brynard amp Hanekom 2005 44
Ghauri et al 199578 Welman amp Kruger 200155-56 Polit amp Hungler 199518)
The data were collected in three phases The first phase of data collection was done through
auditing of hard copies of identified personnel files encomprising ten files per hospital and
using the tools in annexure A and B The forty employeesrsquo profiles were accessed through
the Human Resource Information System (HRIM) located in the Gauteng Department of
Health Head Office The respective employeesrsquo profiles were handed over to the human
resource manager in the respective hospital on the morning of the audit for the human
resource practitioner to draw out the hard copy files for auditing The characteristics of the
individuals that were identified for the first phase were males and females as well as
representatives from the different race groups The auditing of the files were for the
complete working life of the employees and not only confined to 2008 calendar year
Registers that are used by human resource administration to control the movement of the
leave form were inspected as evidence of the control system in place The purpose of
auditing the files was to gain insight into how leave in general was captured managed and
controlled by the hospitals
The second phase of data collection were done through structured interviews with four
human resource managers who were directly accountable for management and control of
leave of absence in general in the four hospitals A structured interview provides for a more
organised approach and a more stable basis for assessment of the different candidates
(Erasmus et al 2005250) The structured interview was conducted using the tool in
annexure C Tara Moross Centre Hospital had been functioning without a human resource
manager and the manager that was interviewed had been in the post for three months The
human resource practitioner who was at salary level 8 and acting in the Assistant Directorrsquos
post (manager level 9) was invited to join the manager and be part of the structured
interview ODI District Hospital had three human resource practitioners including the
accounting officer at level 8 in an acting capacity The third phase of data collection was
through the Human Resource Information Management System (HRIM) This system uses
the Personnel Remuneration Administration System (PERSAL) to collect data Data in this
system is categorised in characteristics such as salary level date of appointment
occupational category gender age in units of five race employing hospital employment
status in different sub-categories such as session contract and full-time and the different
types of leave of absence The continuous sick leave of four to five days was excluded from
processing and focus was laid on sporadic days to the start and end of a weekend
35
The research used secondary data in analysing sick leave utilised by full time employees in
the identified hospitals for the period of 1 January to 31 December of 2008 using Persal The
total population sample was four thousand and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range from level 1 to
12 The research used past events such as sick leave utilised by employees using secondary
data from Persal falling into the category of historical empirical study The interval scale of
measurement was used in the quantitative research and actual numbers are ordered with
equal measurement between each category (Brink 1996 149 Brynard amp Hanekom 200528-
29 Mouton 200552100170)
33 UNIT OF ANALYSIS
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the study refers to observation of work attendance by the
employees of Gauteng Department of Health in the four hospitals The observation deals
with the historical events as employees have already utilised the sick leave in the workplace
The subjects that are studied are the core health care providers such as doctors nurses and
support employees such as allied administration and administration support (Mouton 2005
51-52 Welman et al 2001 52-53)
34 UNIT OF OBSERVATIONS
The observations that are made are of health care employees and support teams in Tara
Moross Centre Hospital Germiston Hospital ODI Hospital and George Mukhari Hospital
and describe the characteristics of a large number of individual people such as sex age
salary range occupational category tenure of service and race in relation to absenteeism in
the workplace The descriptive study and the individual characteristics are aggregated for
the purpose of describing a larger group (Babbie 199292)
35 CONSTRUCT VALIDITY
Construct validity is concerned with the question What construct is the instrument actually
measuring (Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with four of the accounting officers in the leave managements The third phase was
collecting of personnel data through the Persal system
36
36 ETHICAL CONSIDERATIONS
Ethical considerations will include amongst other issues such as the protection of the units
of analysis and units of observations from discomfort and harm by not revealing
information which can cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity
Anonymity is achieved when the researcher cannot link a given response with a given
respondent and reporting aggregate data only When data are collected at one sitting and
not over a period of time makes it possible to achieve anonymity as the need for follow up is
eliminated Subjects of observations are selected for reasons directly related to the problem
being studied as the principle of justice Confidentiality is about the researcherrsquos
responsibility to protect all data gathered within the scope of the study and shared only
with people involved in the research (Babbie 1992465ndash466 Brink 199640ndash41 45 Polit amp
Hungler 1995 31-36)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous to the researcher The interview was part
of the actual audit that was done as part of monitoring and evaluation that was in progress
in the Department of Health following a negative auditor generalrsquos report about
management of leave in general The managers were put at ease as they were given the
checklist afterwards for self-monitoring and for future self-auditing
The data that were collected through Persal identified employees through the Persal
number and kept their identities anonymous The data that were collected through the hard
copy of employeesrsquo files were used to point out areas of concern to the managers and the
files did not leave the office of the manager at the end of the process once more protecting
the identity of the employee
37 CONCLUSION
This chapter dealt with the research design which is the overall plan for relating the
conceptual problem to relevant empirical research The methodology used a stratified
random sample which is composed of various clearly recognisable non-overlapping sub-
populations that differ from one another in terms of variables that are a combination of
more than one variable The data collection was done through three phases The unit of
analysis refers to the persons who are studied The unit of observations are health care
workers and support teams in the four identified hospitals The construct validity used a
multi-trait multi-method approach Ethical considerations include among other issues
protection of the unit of analysis and the unit of observations from discomfort and harm
Chapter 4 discusses the analysis and interpretation of the data gathered in chapter 3
37
CHAPTER 4
INTERPRETATION AND ANALYSIS OF DATA
41 INTRODUCTION
This chapter focuses on the research analysis and interpretation of data gathered on
workplace absenteeism in the Department of Health of the Gauteng Province It seeks to
identify differences or similarities in the leave trends in the 2008 calendar year between the
four identified hospitals chosen for the study in the Municipality of Tshwane Ekurhuleni and
Johannesburg The year 2008 was chosen as a second year in the leave cycle that started in
2007 The type of leave of absence is interpreted as a collective that does not specify the
type of sickness or illness or it being acute or chronic Workplace absenteeism is absence of
the employee at the workplace that is defined by Du Toit and Van Der Waldt (1998139) as
the place that the institution makes available and where officials have to perform their
work It forms part of the internal environment for public administration in the public
service Direct public administration is directly concerned with the rendering of services to
the citizens of the country
Chapter 4 discusses the study of workplace absenteeism in the four identified institutions
namely Tara Moross Centre Hospital Germiston Hospital ODI District Hospital and George
Mukhari Hospital In this research the following factors will be examined the organisational
structure and absenteeism of the different workforce categories such as medical and
nursing professionals administrative staff allied professionals and various categories of the
general assistants workforce and their relation to absenteeism in the institution
42 THE STRUCTURE OF THE ORGANISATION
The Gauteng Province is one of the nine provinces of South Africa In 2005 the auditor-
general conducted an audit of sick leave performance in six national departments and the
Gauteng Province was among those that were omitted from the audit The research focuses
on the Gauteng Department of Health (GDoH) whose core function is to provide health care
services to the people of Gauteng The provision of health care services is labour intensive
and requires large numbers of personnel for effective service delivery The GDoH is serviced
by thirty-four hospitals four of which have been identified for the study of management of
sick leave The employee attendance to work is essential to the achievements of the
Departmental goals The Determination on Leave of Absence determines the leave policy for
public service employees (DPSA 2009) The employees of GDoH represent the staff
component as reflected in the organisational structure of the department
38
The Gauteng Department of Health (GDoH) provides the basic health services to the people
of Gauteng who as internal or out-patients are clients or consumers of the services referred
to as line functions Public administration services rely heavily on support services such as
the personnel department that renders support to line functions that provide the actual
service of patient care Support services are considered as indirect public administration
services and essential in efficient public service delivery Workplace absenteeism has a
negative impact on productivity Employees of the Gauteng Department of Health and their
attendance to work are the focal point of the Province in terms of effective health care
service delivery that is customer focused
Political ideologies as those espoused by labour representatives are part of the external
factors in the workplace environment that consequently have an impact on public
administration and management and workplace attendance by employees (Du Toit amp Van
Der Waldt 1998139170)
FIGURE 41 INTERGRATED ORGANISATIONAL STRUCTURE
(Adapted from Gauteng Department of Health organisational structure 2010)
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY
The Gauteng Provincial Government has made a commitment to its people to account for
the delivery of services as its electoral mandate This commitment will be achieved only
when monitoring and evaluation of its performance is enforced by all Gauteng Department
of Health service providers
39
MEC
HOD
COP
Senior Exec
CD HAST CD Health program
Senior Exc
CD Tshwane
CD JHBWest
CFO
Manage Account
SENIOR CORPORATE
HRM amp LR
GenderampDisability
The Gauteng Governmentrsquos commitment to provision of health care services to all its
citizens is demonstrated by the decentralisation of management of service delivery with the
view to foster accountability increase efficiency and accountability (ANC 199419ndash20
Goldstein 200815) The interpretation of the analysed data takes the sector performance
approach into consideration when the interpretation of absence is across all the
occupational groups for the 2008 calendar year (Gauteng Province 201015)
44 COMPARISON OF HOSPITALSPERMANENT EMPLOYEES
Gauteng employees are counted at 51475 from the Personnel Salary Administration System
(PERSAL) as of March 2008 The population from the four chosen hospitals has been
counted at 4010 reflecting 8 of the total population The different groups of employees
were identified as Africans represented as n=3902 Whites as n=51 Indians as n=14 and
Coloureds as n=43
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALS
(Source Compiled by the researcher C S Ndhlovu 2012)
Figure 42 reflects the racial split percentage of the workforce (n=4010) of the hospitals
The population from the four hospitals has been counted as 4010 reflecting 8 (n=51475)
of the total working population for Gauteng Department of Health as from 1 January to 31
December 2008 The different groups of employees were identified as Africans represented
by 973 (n=3902) Whites as 13 (n=51) Indians as 03 (n=14) and Coloureds as 11
(n=43) The George Mukhari Hospital has a female dominated workforce at 739 (n= 2097)
in a total workforce of n=2836
40
Population n=4010
Africans 973
Whites 13
Coloureds 11
Indians 03
TABLE 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALS
RACE TARA HOSPITAL GERMISTON GEORGE
MUKHARI
ODI TOTAL
Africans 227 367 2836 472 3902
Whites 23 24 3 1 51
Coloureds 5 37 0 1 43
Indians 13 1 0 0 14
Population 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 1 focuses on the distribution of race and the population of the total workforce The
geographical area of the hospital determines the demographics and the tendency of some
groups being poorly represented or totally absent The research focused on permanent
employees of the four hospitals The George Mukhari Hospital employees are reflected as
7079 (n=2839) ODI Hospital as 1182 (n=474) Germiston Hospital as 1069 (n=429)
and Tara Moross Centre Hospital as 668 (n=268) of the total working population Tara
Moross Centre and Germiston Hospitals are located in cosmopolitan areas while the George
Mukhari and the ODI Hospitals are in rural and semirural areas The positioning of the latter
hospitals may account for the high African workforce
41
TABLE 2 COMPARISONS OF NUMBERS OF ADMINISTRATION AND SUPPORT STAFF IN THE
DIFFERENT HOSPITALS
OCCUPATIONAL
GROUP
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Administration
staff
48 60 297 61 466
Administration
support
103 140 719 133 1095
TOTAL 151 200 1016 194 1561
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 2 presents the administration employees and the administration support in the four
hospitals Tara Moross Centre Hospital is represented by 3179 (n=151) of administration
and 6822 (n=103) administration support The George Mukhari Hospital has the highest
representation by the administration support at 7077 (n=1016) The high representation
of the administration support staff at George Mukhari Hospital could be partly because of
the semi-rural environment A semi-rural environment is usually characterised by poverty
which may have a negative influence on opportunities to access education and skills
Doctors and nurses are highly marketable because of the educational levels and skills that
are lucrative and enable this group to be highly mobile geographically (Chaudhury amp
Hammer 20033)
42
TABLE 3 GENDER COMPARISON IN DIFFERENT HOSPITALS
GROUPS HOSPITALS MALE FEMALE POPULATION
Africans Tara 83 144 227
Germiston 52 315 367
George Mukhari 739 2097 2836
ODI 109 363 472
TOTAL 983 2919 3902
Whites Tara 5 18 23
Germiston 5 19 24
George Mukhari 3 0 3
ODI 1 0 1
TOTAL 14 37 51
Indians Tara 1 12 13
Germiston 0 1 1
George Mukhari 0 0 0
ODI 0 0 0
TOTAL 1 13 14
Coloureds Tara 1 4 5
Germiston 6 31 37
George Mukhari 0 0 0
ODI 1 0 1
TOTAL
GRAND TOTAL
8
1006
35
3004
43
4010
(Source Compiled by C S Ndhlovu 2012)
Table 3 focuses on gender distribution in the population of the research represented by
males and females in the different racial groups
43
The geographical area of the hospital determines the demographics and the tendency of
some groups being poorly represented or totally absent The males of the different hospitals
account for 251 (n=1006) while the females account for 749 (n=3004)
The George Mukhari Hospital has a female dominated workforce at 7394 (n=2097) out of
a total workforce of n=2836 White male employees are represented by 011 (n=3) against
the total workforce of the hospital (n=2839) There are no Indians and nor any Coloured
employees African males are represented by 2603 (n=739) The same hospital has no
white female employees no Indians no Coloureds and 7395 (n=2097) African females
The table reflects a predominantly African female workforce The hospital is situated in a
rural setting and this may have an impact on the vast difference in the gender
representation
The Tara Moross Centre and Germiston Hospitals are located in cosmopolitan areas They
have 187 (n=5) and 1117 (n=5) White male employees respectively and 672 (n=18)
and 443 (n=19) female employees respectively Tara Moross Centre Hospital has 4 48
(n=12) female Indian employees while Germiston Hospital has only 024 (n=1) Germiston
Hospital has 723 (n=31) female Coloured employees while Tara Moross Centre has 150
(n=4) The core function of the various hospitals may have influenced the gender
distribution
TABLE 4 COMPARISON OF TENURE OF SERVICE IN RELATION TO ABSENTEEISM IN THE
FOUR HOSPITALS
TENURE IN YEARS DAYS OF ABSENCE PERCENTAGE
1ndash10 4451 30
11ndash20 6577 443
21ndash30 2934 198
31ndash40 878 59
TOTAL 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 4 reflects the level of tenure of the total workforce from 1 year to 40 years of service
Tenure of 11 years to 20 years of service reflects 443 (n=6577) utilisation of leave of
absence and remains the highest rate of absenteeism followed by tenure of 1 to 10 years of
service at a 30 absenteeism rate
44
TABLE 5 COMPARISON OF THE OCCUPATIONAL GROUPS IN THE DIFFERENT HOSPITALS
OCCUPATIONAL
CATEGORIES
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Doctors 12 12 354 19 397
Professional
nurse
47 81 548 109 785
Staff nurse 15 53 358 56 482
Nurse assistant 16 50 308 55 429
Social worker 4 4 8 3 19
Occupational
therapists
4 0 15 1 20
Radiographer 0 3 27 6 36
Clinical
Psychologists
4 0 10 2 16
Physiotherapists 0 1 9 1 11
Dieticians 0 0 5 3 8
Finance 4 11 59 9 83
Speech
therapists
0 0 5 1 6
Pharmacists 2 9 36 5 52
Dentists 0 0 0 3 3
Technicians 2 5 51 6 64
Librarian 1 0 0 0 1
Security 6 0 30 1 37
Administration
and support
151 200 1016 194 1561
TOTAL 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 5 reflects a great difference in terms of number of occupational groups in the four
hospitals
45
The core function and the size of the hospital seems to have a bearing on how many
occupational categories of employees are to be found in that hospital as well as the actual
figures of these categories The George Mukhari Hospital is an academic hospital that trains
medical doctors This hospital has 1247 (n=354) doctors in a staff establishment of
n=2839 Tara Moross Centre has 448 (n=12) in a staff establishment of n=268 Germiston
has 280 (n=12) in a staff establishment of n=429 and ODI District hospital has 401
(n=19) in a staff establishment of n=474 This trend of vast differences in figures
represented by the occupational groups is evident in the category of professional nurses
where George Mukhari Hospital reflects 1931 (n= 548) nurses Tara Moross Centre is
represented by 1754 (n=47) Germiston by 1889 (n=81) and ODI District hospital by
23 (n=109) The impact of absenteeism is pronounced when viewed against the level of
facility capacity in terms of human resources of the core occupational groups
441 The Tara Moross Centre Hospital
Tara Moross Centre Hospital is a speciality psychiatric hospital in Region A with a workforce
of 669 (n=268) of the total workforce (n=4010) The core function of the hospital is
specialised such that some occupational categories are not available in the hospital as part
of the workforce and patients are referred out to other facilities for specialised treatment
Tara Moross Centre Hospital falls under the jurisdiction of the Johannesburg Metropolitan
Municipality
442 The Germiston Hospital
Germiston Hospital is a regional general hospital in Region B with a total permanent staff
establishment of 1070 (n= 429) of the total workforce (n=4010) The hospital falls under
the Ekurhuleni Metropolitan Municipality It does not have occupational therapists clinical
psychologists dieticians speech therapists and dentists in its permanent staff
443 The ODI District Hospital
The ODI District Hospital is in Region C and is in transition due to boundary changes It is
being transferred from the North West Province to the Gauteng Province The hospital is in
a semi-rural area with a staff component of 118 (n=474) of full-time employees (n=4010)
and falls under Tshwane Metropolitan Municipality It is a general district hospital
444 The George Mukhari Hospital
The George Mukhari Hospital is an academic hospital in Region C under Tshwane
Metropolitan Municipality The hospital trains doctors and employs 010 (n=3) White male
employees 26 (n=739) African males and7184 (n=2097) African females out of the
total female workforce (n=2919)
46
This phenomenon may be as a result of the hospital having the highest general assistants
workforce at 2065 (n=586) out of the workforce (n=2839) The George Mukhari Hospital
has the highest number of general assistants out of the four hospitals represented as 25
(n=719) in a total workforce of n=2836 African employees
45 RESEARCH INTERPRETATION
The interpretation of leave of absence is confined to salary level 1 to 12 full time employees
of the Gauteng Department of Health who took leave of absence from the workplace for the
calendar year in 2008 It excludes the contract employees periodic remuneration foreign
employees and permanent employees above salary range 13
The Basic Conditions of Employment Act 75 of 1997 Section 9 (3) (RSA 1997) prescribes
procedures in terms of progressive reduction of the maximum working hours to the goal of
a 40-hour working week and an eight-hour working day Finnemore and Van Rensburg
(2002462) state that the reduction of maximum working hours to 40 hours a week is done
through collective bargaining with due regard to job creation efficiency and health safety
and welfare of employees Du Toit and Van Der Waldt (1998232) use the formula to
aggregate lost working-man hours due to ill health and disability as aggregate lost hours in
the survey period divided by 40 hours in a week and x number of hours in a year A formula
to work out the absenteeism rate by Pierce (2009) is represented as A=BC A= Absenteeism
rate B= Total number of days lost due to absenteeism in a given period C= Total number of
working- man days available in the given period C=D x E D=Total number of employees
planned to work in the given period E=Number of available working days in the given
period
The approach of the research uses the principle of absence from the workplace when due to
work to identify the lost working hours (Pierce 2009 Davey amp Cummings 2009313) The
study applies a retrospective approach
The working-man lost days for the Province in the four hospitals is approached in terms of
lost working -man days simplified refers to the number of days meant to have been worked
but actually not worked due to illness or disability by the employees in a year divided by the
total number of employees of the public sector (PXVI) Barker (200779) argues that a
reduction in working hours increases the hourly cost of production and unit production
unless there is a commensurate increase in productivity This approach has a similar effect
on workplace absenteeism when the workload of those employees who are present
increases as they carry the double load to meet the demands of service delivery The cost of
absence to the Province is expressed as salary expenditure for each day of leave of absence
from the workplace (PSC 2002 xiii Pierce 2009)
47
The salary range is laid down according to Annexure in DPSA Circular 1 of 2008 The Gauteng
Government experienced a cost estimated at R29 million in 2000 and approximately R54
million in 2001 from absenteeism and loss of working time (Parbhoo20031)
The formula that is used in this research to calculate lost man work-hours is collective
working days of absence multiplied by 8 hours in a working day resulting in the total
working hours that are lost This formula can be represented as
Lost days x hours (8) in a working day = lost working hours
As stipulated by the Basic Conditions of Employment Act 75 of 1997 section 9 1(c) 3
TABLE 6 RACES IN RELATION TO ABSENTEEISM
RACE TOTAL DAYS OF ABSENTEEISM PERCENTAGE
Africans 14295 963
Whites 242 16
Coloureds 201 14
Indians 102 07
TOTALS 14840 100
(Source Compiled by the researcher 2012)
Table 6 represents absenteeism in the diverse races in the workplace The absenteeism rate
seems to be proportional to the number of employees The Employment Equity Act 55 of
1998 defines the term ldquoblackrdquo as a generic term which means Africans Coloureds and
Indians The Africans as a race group is represented by 963 (n=14295) of the total
working days lost (n=14840) The high figure of lost working-man days reflects the
demographics of the four hospitals The George Mukhari Hospital is in a rural setting that is
predominantly African populated and employs the highest number of Africans as
represented in table 3 Whites are presented by 16 and not represented in all
occupational categories and salary ranges that could explain the low figures and
percentages associated with working-man days lost Africans constitute the highest number
of employees as well as the highest percentage of working-man days lost Absenteeism
percentage is proportional to the employment figures for this race group The Indian race
group is represented by the lowest figure of employment and lowest percentage of leave of
absence which is proportional to the employment figure
48
TABLE 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM
OCCUPATIONAL
GROUPS
TARA GERMISTON ODI GEORGE
MUKHARI
TOTALS
DOCTORS 22 118 5 290 435
PROFESSIONAL NURSE 272 346 20 2459 3097
STAFF NURSE 128 247 13 1568 1956
NURSE-ASSISTANT 150 126 25 1145 1446
FINANCE 0 0 0 386 386
ADMINISTRATION 57 272 20 1923 2272
ADMIN SUPPORT 754 547 163 3784 5248
TOTAL 1383 1656 246 11555 14840
(Source Compiled by C S Ndhlovu 2012)
Table 7 reflects the working-man days lost by the different occupational groups The
doctorsrsquo workload in terms of the annual report for Gauteng Department of Health
(2008951) was 226 as against the target of 227 while the national target was 187
The bed occupancy rate target for the same time was 75 while the actual figure was
653 The annual report interpreted in conjunction with the data of leave of absence for
doctors reflects a negative impact in terms of service delivery and the cost factor to the
department
451 Occupational groups in relation to absenteeism
The multi-group invariance structural model presents different types of occupations and is
used to identify variance in the patterns in terms of occupational groups The model allows
different relationships between variables in different occupations The different
occupational groups are doctors professional nurses and sub-categories administration
staff and administration support staff (Pousette amp Hanse 2002230) According to Gaudine
and Gregory (2010599) absenteeism was a problem among health care workers in
comparison to other employees in other sectors The cornerstone of an efficient health care
service delivery is equity and efficiency which is threatened when employees are not at
work when expected to be (Andrews 199734-35 DPSA 1997)
49
According to the Charted Institute of Personnel Development (200811) the survey that was
conducted found that public sector employees are less likely to be disciplined or dismissed
for reasons of workplace absenteeism
Tables 5 and 6 and 7 reflect the different occupational groups and the level of absenteeism
in the four hospitals of the Gauteng Department of Health
4511 Doctors
Doctors are represented by 10 (n=397) of the total working population (n=4010) The
29 (n=435) indicates the number of working-man days lost in relation to the total
working- man days lost (n=14840) The percentage of working- man days lost in relation to
the total number of full time employees of the four hospitals is reflected as 435 divided by
n=4010 times the percentage which results in 108 (n=435) working-man days lost
multiplied by 8 hours that represent a working day The outcome is n=3480 working-man
hours The cost to the Province is calculated in terms of the salary expenditure as direct and
indirect salary payment for lost working-man hours estimated at 3480 hours at salary level
10 at R217 482 to salary level 12 at R 407745 as well as indirect costs such as replacement
of staff and overtime
The doctorsrsquo workload in terms of Gauteng Province 20089 annual report (2008951)
reflects the doctorrsquos workload as 226 as against the target of 227 while the national
target is reflected as 187 The bed occupancy rate target for the same time is 75 while
the actual target rate is 653 The annual report when interpreted in conjunction with the
data of leave of absence for doctors reflects a negative impact in terms of service delivery
and the cost factor to the Department when considering a loss of n=3480 man hours of
work
Chaudhury and Hammer (200311) found in their research that the doctors presented the
highest absenteeism rate Serneels et al (2008210) argue that absenteeism is rife in the
public sector where employees hold two jobs and is highest among doctors The doctor
absenteeism rate in the research does not stand out as high in comparison with the other
occupational groups The doctor absenteeism rate is 29 when compared to the total
workforce This occupational group is represented by 10 of the total population The
doctorsrsquo absenteeism rate does not seem to be outstandingly high in comparison with the
other occupational groups in relation to the total number of permanent doctors
50
4512 Professional nurses
The professional nursesrsquo absenteeism is reflected as 208 (n=3088) that indicates the
number of working-man days lost in relation to the total working-man days lost (n=14840)
The percentage of working-man days lost in relation to the total number of full time
employees (n=4010) in the four hospitals is reflected as 77 The cost to the Province
translates into direct and indirect salary expenditure which is spread from salary level 4 to
12 at R64 410 to R407 745 in 2008 for the total duration of lost working days
Du Toit and Van Der Waldt (1998232) pointed out a crisis in four other public hospitals in
the Gauteng Province that was caused by budget cuts and shortage of doctors and nurses in
2008 The vacancy rate of 697 in the professional nurse category and the absence rate of
208 in 2008 in the four hospitals seem to point to a lack of adequate human resources for
effective health care delivery The extent of working-man hours lost in the findings of the
research suggest a high rate of absenteeism and not a good reflection of happiness as
suggested in the annual report Professional nurses are second to the administration
support in absenteeism at 208 at a total of (n=785) nurses in the four hospitals with
absenteeism of n=3088 working-man days lost or n=20704 working-man hours lost This
category of employees is classified as skilled to highly skilled at salary range of 4 to 12The
total vacancy rate was at 697 as against the national target at 15 in 2008 with
absenteeism of 208 Madibana (201022) found in the research about absenteeism
among nurses that the high rate of absence had a negative impact in the quality of health
care rendered by nurses
4513 Staff nurses
Staff nurses are reflected in tables 4 and 5 as representing 12 (n=482) of the total working
population (n=4010) The 132 (n=1956) indicates the number of working-man days lost
in relation to the total working-man days lost (n=14840) times the percentage
The percentage of working-man days lost in relation to the total number of full time
employees in the four hospitals is reflected as 488 The cost to the Department is
expressed as direct and indirect salary expenditure for n=15648 working-man hours lost
The impact of leave of absence to health care services and cost to the Department is the
same as the professional nurses as staff nurses are a sub-category of the nursing profession
4514 Nursing assistants
Nursing assistants are reflected in tables 4 and 5 as represented by 107 (n=429) of the
total working population (n=4010) and 97 (n=1446) represent working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The
percentage of working-man days lost is reflected as 36 (n=1446) in relation to the total
number of employees in the four hospitals (n=4010)
51
The cost of leave of absence to the Department is expressed as the salary expenditure at
salary levels 3 to 6 Salary level 3 is at R54 876 salary level 4 is at R64 410 salary level 5 at
R76 194 and salary level 6 is at R94 000 for n=11568 working-man hours lost and staff
replacement and overtime
4515 Finance officers
Finance officers are reflected in tables 5 and 7 as represented by 21 (n=83) of the total
working population (n=4010) and 26 (n=386) indicates the working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The cost to the
Department is reflected as salary expenditure from salary level 2 at R47 787 to salary level
10 at R217 482 for R2 728 working hours lost The institutions reflected a small number of
this occupational category as permanent employees place them in the category of scarce
skills
4516 Administration staff
The administration staff is represented in tables 2 and 4 and 5 by 116 (n=466) in the total
working population (n=4010) and 153 (n=2272) indicates the working-man hours lost in
relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 567 represent the working-man days lost in relation to the total number of
full time employees in the four hospitals (n=4010) The cost of leave of absence to the
department is reflected as salary expenditure at salary level 4 to 12 Salary 4 at R64 410 to
salary level 12 at R407 745 for 18176 working hours lost
4517 Administration support
The administration support is reflected in tables 2 and 4 and 5 as represented by 273
(n=1095) of the total working population 354 (n=5248) indicates the working-man days
lost in relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 1309 (n=5248) indicates the working-man days lost in relation to the total
number of employees in the four hospitals (n=4010) The total cost to the Department is
reflected as salary expenditure at salary level 2 to 3 at a cost of R47 787 to R54 879 for
41984 working -man hours lost
The highest percentage of absenteeism in the different categories of employees in the four
hospitals is identified in the administration support category It is this category that falls into
the salary range of 2 and 3 which is classified in the Gauteng Province 20089 annual report
(20089325) as lower skilled employees This category represents the highest single
category of employees for the Department at n=1095
52
The impact to the core service delivery employees that require support from administration
staff would seem to be negative as the absence of employees from the workplace would
hamper the smooth workflow Barker (2007214-224) acknowledges the decline in the flow-
through rate in the school education higher grades namely Grade 11 and Grade 12 and
ventures to give possible reasons for this phenomenon The Gauteng Department of Health
as a possible employer has attracted a high percentage of the labourer category as
identified in table 3 totalling n=1095 which is 273 of the total workforce Pousette and
Hanse (2002230-231) suggest that the employeersquos authority to make decisions in his or her
job and the breadth of use of skills used by the employees at work become different aspects
of control with human service at work This approach suggests that reduced job autonomy is
associated with higher sickness absence The administrative support employees are involved
in mechanical or manual labour that predisposes them to musculo-skeletal problems The
work environment could have a negative impact to the high absenteeism rate in this group
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM AS REPRESENTED BY
THE HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 43 reflects the absenteeism rate of the different occupational groups as represented
by the hospitals The George Mukhari Hospital contributes 7079 to the total workforce
and contributes about 779 to absenteeism The absenteeism rate does seem to be low at
7 when considered in the light of the contribution The question that maybe be raised is
whether the relative low absenteeism is indicative of high morale of a happy workforce
53
ODI 17
TARA 93
GERMISTON 111
GEORGE MUKHARI 779
Germiston Hospital contributes 106 to the total workforce and the absenteeism is
reflected as 111 which seems to be above its contribution to the workforce by 1 The
professional nurse and the administration category present with the highest rate of
absenteeism in this hospital The Tara Moross Centre Hospital contributes 67 of the total
workforce and the absenteeism rate is at 93 which is 26 higher The administration
support and professional nurses present with the highest level of absenteeism in this
hospital The ODI Hospital contributes 6 to the total workforce and the absenteeism rate
which seems to be low is reflected as 17 This hospital has no access to the Persal system
and is dependent to a neighbouring hospital It is highly probable that the information is not
accurate
Allen (1984 331) found that union members might be absent more frequently from the
workplace than non-members because they face smaller penalties for absenteeism The
Charted Institute of Personnel and Development (CIPD) (200811) claim that the 2006
survey of absence management portrays the public sector employees as less likely to be
dismissed for reasons of workplace absenteeism
TABLE 8 SALARY RANGE IN RELATION TO ABSENTEEISM (SALARY RANGE 1-12)
SALARY RANGE DAYS OF ABSENCE PERCENTAGE
1-2 178 12
3-4 5235 353
5-6 2044 138
7-8 5139 346
9-10 1878 126
11-12 366 25
TOTAL 14840 100
(Source Compile by the researcher C S Ndhlovu 2012)
Table 8 reflects the salary range with the lowest working days lost as salary level 1 to 2 This
is proportional to the number of employees The highest absenteeism rate has been noted
in the salary range at level 3 to 4 while salary ranges at level 11 to 12 reflected a low rate of
absenteeism The latter salary range is at middle management level and the responsibility
the employees carry may be responsible for the low absenteeism rate Rogers and Hertin
(1993219) noted that the level of education seem to have influenced the use of sick leave
where the lower level category employees were found to have higher level of absenteeism
than higher educated employees
54
TABLE 9 AGE IN RELATION TO ABSENTEEISM
AGE IN YEARS DAYS OF ABSENCE PERCENTAGE
20 to 24 16 010
25 to 29 405 272
30 to 34 733 493
35 to 39 1582 1066
40 to 44 2676 1803
45 to 49 3318 2235
50 to 54 3046 2052
55 to 59 2235 1506
60 to 64 829 558
TOTAL 14840 9999(100)
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 9 reflects age in relation to absenteeism in the four hospitals The age group at 20 to
24 years reflects the lowest figure in working-man days lost at 010 (n=16 days)
Reday-Mulvey (200579) observed that employees over 45 years take marginally fewer short
sick leave days per year than those under 45years
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 to 55 years
as middle -age and shows this group as presenting with a high incapacity leave usage In the
research the age group 45 to 49 years presented with 2235 (n=3318) working-man days
lost and is the highest figure of absenteeism in all age groups The age group at 20 to 24
years is reflected as the lowest absenteeism rate in working-man days at 010 and this
could be related to the number of employees in this age group
According to Reday-Mulvey (20057988) and the Canadian Nurses Association (20065)
employees that are over 45 years take marginally fewer short sick leave periods but take
slightly longer sick days per year than those under 45 years and reflect higher absenteeism
in the age group above 50 years
55
Weeks (200454) found that employees at the age group represented by 51 to 60 years
show less absence which may be because of ill health retirement benefits The age 31 to 40
and 41 to 50 years show higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full time jobs and suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee In the study the age group 55 to 59 years show a decline in absenteeism in
comparison to 50 to 54 while age 60 to 64 shows the lowest rate
The aging employee has been found to expose the institutions to high levels of absenteeism
through a higher probability of becoming incapacitated for longer periods (Ferguson et al
200138) and the current research have pointed differently Rogers and Hertin (1993219)
found a significant correlation between the use of sick leave and age suggesting employees
with advanced age used more sick leave in comparison with the younger employees The
current socio-economic culture encourages retirement from active employment at the age
of 65 years and the research adopted that approach as a cut off point for employment
(Nichols amp Evangelisti 2001285)
TABLE 10 GENDER IN RELATION TO ABSENTEEISM
GENDER TOTAL
NUMBER
DAYS OF
ABSENCE
PERCENTAGE
Males 1006 2490 168
Females 3004 12350 832
Total 4010 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 10 reflects gender in relation to absenteeism The duration of working-man days lost
is higher in female employees at 8325 (n=12350) and is represented by 749 (n=3004) in
relation to the total number of employees in the four hospitals (n=4010) as represented in
table 3 The male employees employed by the Department are reflected as absent from
work by 1680 (n=1006) and represented as 251 in relation to the total number of
employees in the four hospitals (n=4010)
The Public Service Commission (PSC 200222) found that more males took sick leave than
females except for the age group of 16 to 19 years QUALSA (200923) noted that females
had the highest number of incapacity applications in comparison to their male counterparts
Qualsa attributed this pattern to the fact that female employees constitute a higher
percentage of the employee population within the Gauteng Department of Health
56
Roger and Hertin (1993222) noted that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees could have an
impact on the high number of absenteeism reflected by the women
452 Race in relation to absenteeism
The working population of the four hospitals is represented by four race groups such as
Africans Whites Coloureds and Indians
4521 Africans
Africans represent 973 (n=3902) of the total working population (n=4010) and 963
(n=14295) indicates the working-man days lost in relation to the total working-man days
lost (n= 14840) times the percentage 3565 (n= 14295) reflects the working-man days
lost in relation to the total number of employees in the four hospitals (n=4010) The 14295
working-man days lost are multiplied by 8 hours that represent a day and translates into
963 (n=114360) working-man hours lost The cost to the Department is translated as
salary expenditure for n=114360 workingndashman hours lost and the indirect cost of staff
replacement and overtime Africans constitute the highest number of employees as well as
the highest percentage of working-man hours lost Absenteeism percentage is proportional
to the employment figures for this race group
4522 Whites
Whites are represented as 13 (n=51) of the total workforce (n=4010) and 16 (n=242)
represent the working-man days lost in relation to the total working-man days lost
(n=14840) times percentage 61 (n=242) represent working- man days lost in relation to
the total number of employees in the four hospitals The 232 working-man hours lost are
multiplied by 8 hours that represent a working- man day that translates into 16 (n=1856)
working-man hours lost The cost to the Department is represented as salary expenditure of
(n=1856) working-man hours lost that is paid to the unproductive employees This race
group of employees is not represented in all occupational categories and salary ranges
which may explain the low figures and percentages associated with working-man days lost
(n=242) The demographics of the different hospitals may contribute to the low
representation of this group in the total workforce
4523 Coloureds
Coloureds are reflected as 11 (n=43) of the total workforce (n=4010) 14 (n=201)
represent working- man days lost in relation to the total working- man days lost (n=14840)
5 (n=201) indicates working- man days lost in relation to the total number of employees in
the four hospitals (n=4010)
57
The cost to the department is represented as salary expenditure for n=1608 working-man
hours that are lost This race group is represented in three of the four hospitals and not in
all categories and salary ranges which may explain the low representation and
absenteeism
4524 Indians
Indians represent 03 (n=14) of the total workforce (n=4010) in table 6 07 (n=102)
represent working- man days lost in relation to the total working- man days lost (n= 14840)
times percentage 25 (n=102) indicates working- man days lost in relation to the total
number of employees in the four hospitals (n=4010) The 102 working- man days lost are
multiplied by 8 hours that represent a working-man day and translates into 07 (n=816)
working- man hours lost The cost to the Department is expressed as salary expenditure
paid to the unproductive employees for duration of (n=816) working-man hours lost This
race group is not represented in two of the four hospitals in some occupational categories
and salary ranges The Indian race group is represented by the lowest figure of employment
and lowest percentage of leave of absence which is proportional to the employment figure
FIGURE 44 RACES IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 44 reflects the different races in relation to absenteeism The Africans as a race
group is represented by 963 of working-man days lost (n=14840) The high figure of lost
working-man days reflects the demographics of the four hospitals
58
14840 DAYS
(100)
Africans 963
whites 16
coloureds 14
Indians 07
The George Mukhari Hospital is in a semi-rural setting that is predominantly African
populated and employs the highest number of Africans as represented in table 1 (n=2836)
Whites are presented by 16 absenteeism rate and not represented in all occupational
categories and salary ranges which could explain the low figures and percentages associated
with lost working days The absenteeism rate for Indians is represented as 07 and
Coloureds as 14
The Africans as a race group constitute the highest number of employees as well as the
highest percentage of working days lost Absenteeism percentage is proportional to the
employment figures for this race group The Indian race group is represented by the lowest
figure of employment and lowest percentage of leave of absence which is proportional to
the employment figure The South African Survey Millennium (1999-200028) reflected the
African males in 1998 as 354 and females as 348 the Coloured males as 39 and
females as 46 Indian males as 39 and females as 15 and White males as 83 and
females as 94 There has been no significant change in the race group representation in
the working population of the four hospitals
453 Tenure in relation to absenteeism
Tenure in years is grouped in units of ten (10) Tenure in 1 to 10 years 11 to 20 years 21 to
30 years 31 to 40 years of all occupational groups are represented in figure 27 as the total
leave of absence utilised by the full-time employees of different occupational groups in
terms of tenure which translates into n=14840 working-man days lost The lowest hours lost
is at tenure 31 to 40 years of service which is reflected as 59 (n=878) working- man days
lost The highest working-man days lost is at tenure of service of 11 to 20 years reflected as
443 (n= 6577) working- man days lost Tenure of service of 1 to 10 years reflects 30
(n=4451) working-man days lost and tenure of years at 21 to 30 years reflects 198 (n=
2934) working- man days lost
Rogers and Hertin (1993222) express tenure as work experience in years that is viewed as a
predictor of employee productivity where seniority has been found to be inversely related to
absenteeism in terms of frequency and total number of work days lost The Canadian Nurses
Association (20065) suggests that job tenure increases with age as illustrated in their
research where nurses were found to have both job tenure of 20 years or more and are over
45 years of age In the research the tenure of 31 years to 40 years presented with the lowest
absenteeism rate in agreement with Rogers and Hertin (1993222)
59
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 45 reflects the total leave of absence from tenure of 1 year to 40 years The PERSAL
system reflected 40 years as representing more or less 64 years of age and 65 years is the
cut off point for full time employees in the system The lowest working- man days lost is at
tenure of 31 to 40 years of service which is reflected as 590 and represents the older
employee in general The highest working- man days lost is reflected at tenure of 11 to 20
which is presented as 4430 representing the younger employee This is an area of concern
as table 5 reflects professional nursesrsquo absenteeism rate at 208 and administration
support staff at 356 and is possible that the absenteeism rate of the two occupational
categories may be a bigger contributor to the high absenteeism rate reflected in the tenure
of 11 years to 20 years
454 Salary range in relation to absenteeism
The salary range is interpreted in the study as a salary broad band that is represented in
table 9 and ranges from level 1 to 12 Rogers and Hertin (1993 219) claim that the level of
education does seem to have a bearing on the salary range use of sick leave where the
lower level category employees were found to have higher levels of absenteeism than the
higher educated employee The Human Resource Development Strategy (Gauteng Province
200815214) claims that the chances of entering into a higher income bracket in South
Africa rises noticeably after people have twelve years of education The ages 20 to 24 years
are greatly affected by this assumption
60
0
20
40
60
Tenure 1-10Tenure 11-20
Tenure 21-30Tenure 31-40
30 4430
1980
590
Tenure
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 46 above reflects the salary range from 1 to 12 in relation to working- man days lost
as salary range 1 to 2 as n=178 working-man days lost which converts to 12 The highest
absenteeism rate has been noted in the salary range at level 3 to 4 at 3530 (n=5235)
working-man days lost while salary ranges at level 7 to 8 is reflected as the second highest
level of absenteeism at 346 (n=5139) lost working-man days
Salary range at 5 to 6 is reflected as the third highest in absenteeism at 138 (n=2044) lost
working-man days Salary range 9 to 10 is regarded as the entry point to middle
management and is reflected as the fourth highest at 126 (n=1878) working-man days
lost Salary range at 11 to 12 is regarded as middle management entrusted with high levels
of authority and accountability This group is reflected as losing 25 (n=366) working- man
days lost which is considered to be a reasonable low level of absenteeism
455 Age of full time employees in relation to absenteeism
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 years to 55
years as middle-age and shows this group as presenting with a high incapacity leave usage
In the research the age group of 45 years to 49 years is represented with 2235 (n=3318)
working- man days lost and is the highest figure of absenteeism in all age groups
61
178
5235
2044
5139
1878
366
0
1000
2000
3000
4000
5000
6000
Salary range1-2
Salary range3-4
Salary range5-6
Salary range7-8
Salary range9-10
Salary range11-12
DAYS OF ABSENTEEISM
Reday-Mulvey (20057988) and Canadian Nurses Association (20065) observed that
employees over 45 years take marginally fewer short sick leave periods but take slightly
longer sick days per year than those under 45 years and reflect higher absenteeism in the
age group above 50 years
Weeks (200454) claims that the age group at 51years to 60 years show less absence may be
because of ill health retirement benefits The age group of 31 years to 40 years and 41years
to 50 years show a higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full-time jobs He suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee The aging employee has been found to expose the institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods
(Ferguson et al 200138)
Rogers and Hertin (1993219) claim that there is a significant correlation between the use of
sick leave and age suggesting employees with advanced age comparatively used more sick
leave in comparison with the younger employees The current socio-economic culture
encourages retirement from active employment at the age of 65years and the research
adopted that approach as a cut off point for employment (Nichols amp Evangelisti 2001285)
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 47 reflects the number of working-man days lost by full-time employees through
absenteeism related to a specific age
62
16
405
733
1582
2676
3318
3046
2235
829
0
500
1000
1500
2000
2500
3000
3500
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Days of absence
Days of absence
Age groups are organised in units of 5 to be consistent with the Personnel and Salary
Administration System (PERSAL) The age group at 20 years to 24 years reflects the lowest
percentage of absenteeism at 010 (n=16) working-man days lost and the age group of 45
years to 49 years reflect the highest days of absenteeism at 2235 (n=3318)
456 Gender in relation to absenteeism
The females employed in the Department of the four hospitals are represented as 749
(n=3004) in relation to the total number of employees in the four hospitals (n=4010) and
lost 8320 (n=12350) working-man days This absenteeism rate is considered high
considering that not every female employee may have used sick leave The male employees
employed in the Department are represented by 25 (n=1006) of the total workforce
(n=4010) and lost 168 (n=2490) working-man days The findings suggest that males
utilised fewer days of sick leave considering the fact that not every male employee may
have utilised sick leave for the duration of the study
The Public Service Commission (PSC 200222) claims that more males took sick leave than
females except for the age group of 16 years to 19 years QUALSA (200923) noted that
females had the highest number of incapacity applications compared to their male
counterparts Qualsa attributed this pattern to the fact that female employees constitute a
higher percentage of the employee population within the Gauteng Department of Health
Rogers and Hertin (1993222) argue that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees may have an
impact on the high rate of absenteeism
63
FIGURE 48 GENDER IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 48 reflects gender in relation to absenteeism The females employed by the
department in the four hospitals are reflected as absent from work at a rate of 8320
(n=12350) working-man days and represented by 749 (n=3004) in relation to the total
number of employees (n=4010) in the four hospitals The male employees employed by the
Department are reflected as absent from work at 1680 (n=2490) and represented as
251 (n=1004) in relation to the total number of employees in the four hospitals
(n=4010)
457 Week days in relation to occupational groups
Table 11 reflects the trends in terms of days of the week that show high utilisation by the
different occupational groups Mondays Fridays and Thursdays reflect a high utilisation rate
by the employees suggesting a pattern of high absenteeism rate over weekends
Professional nurses and sub-categories and the administration support group reflected the
highest absenteeism over the weekends
64
1680
8320
000
1000
2000
3000
4000
5000
6000
7000
8000
9000
Males Females
GENDER ABSENCE
TABLE 11 WEEK DAYS IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
OCCUPATIONAL
CATEGORY
MONDAY TUESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Doctors 18 8 13 17 0 0
Professional
Nurse
135 86 94 137 0 0
Staff Nurse 52 38 56 65 2 0
Nursing
Assistant
62 27 34 45 2 0
Administration
Staff
64 38 58 73 1 0
Administration
support
252 147 98 126 26 15
Finance officer 17 4 8 16 0 0
TOTAL 600(4) 348(23) 361(24) 479(32) 31(02) 15(010)
(Source Compiled by C S Ndhlovu 2012)
Table 11 reflects the pattern of how the different occupational groups utilised sick leave on
the different days of the week It illustrates the days that sick leave started on each day of
the week The largest number of incidences of sick leave commence on Monday the first
working day of the week as reflected by 4 (n=600) of the days of the weekend Fridays are
the second highest days of absenteeism represented by 32 (n=479) Tuesdays and
Thursday are almost the same in utilisation as reflected by 23 and 24 respectively
Professional nursesrsquo absenteeism was pronounced on Mondays as 2250 (n=135) and
Fridays as 2861 (n=137) a trend that shows possible long weekend absenteeism
The administration support staff has been reflected as mostly absent on Mondays 42
(n=252 days) and Fridays 2631 (n=126 days) The administration support reflected the
highest days of absenteeism on Saturday (n=26) and Sunday (n=15) The Canadian Nurses
Association (CNA) (2006) focused on seasonal pattern of absenteeism in the different
categories in the different hospitals The PSC (2002) report identified a trend by provincial
employees of using sick leave to extend their weekends The research considered working-
man days lost in terms of days of absence as in accordance with evidence of a medical
certificate Administration support is the only group that seem to have utilised Saturdays
for sick leave 8387 (n=26) and Sundays 100 (n=15) days
65
TABLE 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALS
INSTITUTIONAL
CONTRIBUTION
TARA MOROSS
CENTRE
GERMISTON ODI GEORGE
MUKHARI
TOTAL
Contribution to
Sample
668 1070 1182 7080 100
Contribution to
Absenteeism
842 1177 165 7816 100
(Compiled by C S Ndhlovu 2012)
Table 12 reflects the contribution of each hospital to absenteeism Tara Moross Centre
Hospital contributed 67 to the sample and the absence rate is higher than the
contribution at 84 The Germiston Hospital contributed 107 to the sample and the
absenteeism rate is higher at 117 The George Mukhari Hospital contributed 708 to the
sample and absenteeism rate is at 782 and ODI Hospital contributed 118 and
absenteeism rate is at 17 The latter hospital has no computers at The reflection of the
status of absenteeism is likely to be inaccurate The George Mukhari Hospital has the
highest contribution to the sample yet leave of absenteeism is tolerable It raises questions
as to what should be the contributory factor to the leave of absence status in this hospital
46 CONCLUSION
Chapter 4 presented the analysed data in terms of the characteristics as determined in the
stratified random sampling The characteristics and their association with absenteeism have
been presented such as occupational categories age gender tenure of service and race
The research identified which days of the week were utilised for sick leave absence The
contribution of each hospital to absenteeism was identified and a brief overview of each
hospital was presented
Chapter 5 presents the findings conclusion and recommendation of the research
66
CHAPTER 5
FINDINGS CONCLUSIONS AND RECOMMENDATIONS
51 INTRODUCTION
Chapter 1 provides a general introduction to the research It included the background and
motivation for the research that provides the context the problem statement and the
significance of the research The key concepts are defined The research design the method
of data collection the sampling method data analysis and interpretation and limitations to
the research are explained in this chapter
Chapter 2 considers the theoretical foundations concepts characteristics theories
approaches and classifications of workplace absenteeism The discussions on the conceptual
framework of absenteeism predictors of absenteeism and various models of absenteeism
are presented Measures to control workplace absenteeism and the impact of absenteeism
in an institution and management intervention strategies in workplace absenteeism were
discussed
Chapter 3 describes the research design and the different aspects of the research methods
that were applied to the research The chapter explains the various data collection
techniques that are used unit of analysis units of observations construct validity and
ethical considerations
Chapter 4 provides the organisational structure of the Gauteng Department of Health
comparisons of hospital employees different race groups of the four hospitals gender
comparisons in different hospitals and comparisons of the different occupational groups It
provides a short description of the target hospitals The research interpretation is discussed
in terms of the different occupational groups and absenteeism different races and
absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism The trends of week days of
absenteeism in the four hospitals and contributions to absenteeism by the four hospitals are
presented
Chapter 5 explains a synthesis of the study and evaluation of workplace absenteeism The
findings of the research and recommendations are discussed
52 FINDINGS
The findings of the research reflect doctors as represented by 108 in the total workforce
(n=4010) have an incidence of 29 (n=435) of the total work-man days lost (n= 14840) by
the employees in the four hospitals translating to a total of n=3480 working hours lost
67
The working-time lost is considered against the doctorsrsquo workload of 226 in contrast to the
target of as 227 while the national target was 187 The bed occupancy rate target was 75
while the actual figure was 653 The annual report when it is interpreted in conjunction
with the sick leave absence of doctors at 29 shows no negative impact on the workload in
terms of service delivery The negative impact is mainly on the cost factor to the state as the
doctorrsquos salary level is from salary level 10 at a cost of R217482 to salary level 12 at
R407745 (Gauteng Province annual report 2008951) Serneels et al (2008210) claim that
absenteeism occurs primarily in the public sector associated with people who hold two jobs
and that is highest and more frequent amongst doctors The findings of the research of
absence of 29 with a contribution of 2 to the sample are in disagreement with the
Serneels et al findings
Professional nurses represent 196 (n=785) of the total workforce (n=4010) The
workplace absenteeism is represented as 77 (n=3088) of the total workforce (n=4010)
translating into 21 of working-man days that are lost (n=14840) The absenteeism rate
appears to be very high given the fact that nurses by virtue of their numbers are the
backbone of health care service delivery (DPSA 2009) The Gauteng Province annual report
of 2008951 reflects the total vacancy rate of nurses at 697 as against the national target
of 15 The absenteeism rate of 77 is very high when compared with the total vacancy
rate and 19 contribution to the sample Staff nurses are a sub-category of the nursing
profession and the impact of their absence to service delivery is the same as the
professional nurses The findings of the study reflect staff nurses representing 12 (n=482)
of the total working force (n=4010) The absenteeism from staff nurses is reflected as 13
(n=1956) of the total working-man days lost (n=14840) The absenteeism rate does appear
to be high when considering the contribution of 13 to the absence rate by a sample of 12
to the total working-man days lost Nursing assistants are a sub-category of the nursing
profession that is reflected as 107 (n=429) of the total number of employees (n=4010)
and represent 97 (n=1445) of the total working-man days lost (n=14840) This absence
rate is considered as high when compared with the total number of employees
The nursing occupational group considered collectively contributed to absenteeism at the
workplace at 997 which is extremely high Davey and Cummings (2009312-313) claim
that frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased
staff morale and high cost to health care The high absenteeism rate has a negative impact
on health care service delivery
The findings of the research reflect administration staff as 116 (n=466) of the total
number of employees (n=4010) represented by 154 (n=2286 days) of the total working-
man days lost (n=14840) Administration support is at salary level 1 to 2 with exceptional
instances of salary level 3 to 4
68
Administration support staff is reflected as 273 (n=1095) of the total workforce (n=
4010) represented by 356 (n=5289 days) of the total working-man days lost (n=14840)
translating to n=42312 lost working-man hours
The administration staff viewed collectively contributed 51 to absenteeism which is very
high with the support staff reflected as 356 Rogers and Hertin (1993219) claim that the
level of education seem to have influenced the use of sick leave where the lower skilled
category of employees were found to have higher levels of absenteeism than higher
educated or skilled employees The findings of the research reflect the administration
support staff to be in line with the Roger and Hertin findings
The Gauteng Department of Health has a limited number of finance officers causing them to
be a scarce skill occupational group The finance officers represent 2 (n=83) of the total
workforce (n=4010) The working-man days lost are reflected as 23 (n=341) of the total
working-man days lost (n=14840) The total absence at 23 is higher than the actual
contribution to the sample at 2
The age group of 45 years to 49 years reflects the highest absenteeism rate at 224
(n=3318) the age group at 50 years to 54 years is reflected as 205 absenteeism The age
group 40 years to 44 years reflected as 18 absent from the workplace The age group of 55
years to 59 years is reflected as 15 absenteeism Employees of advanced age used more
sick leave in comparison with the younger employees This phenomenon could be attributed
to the ageing process of the body and the onset of incapacity Absenteeism has been found
to be higher in employees who are over 50 years of age and the phenomenon is attributed
to age and changing abilities that increase when work is performed full- time The findings
of the research reflect the age group over 50 years at 205 and reflect the highest
absenteeism rate at age 45 years to 49 years as 224 (McGoldrick amp Arrowsmith 200184
MINTRAC 20093 Nichols amp Evangelisti 2001285 Reday-Mulvey 200579-194) According to
Ferguson et al (200138) the aging employee presents with high levels of absenteeism
through higher probabilities of becoming disabled for longer periods The findings of the
study reflect absenteeism of the age group of 55 years to 59 years at 15 which is the
lowest in the age groups The Canadian Nurses Association in (20065) noted a reduction in
workplace absenteeism rate among nurses who are less than 45 years of age and an
increase in the absenteeism rate among nurses above 55 years of age According to Bangali
(20043-4) the falling rate of the older employee age group could be influenced by the
practice of early retirement or voluntary severance which was used in the 1990s as a
method of restructuring in institutions Rogers and Hertin (1993219) claim employees with
advanced age used more sick leave in comparison with the younger employees
69
The group at tenure 11 to 20 years presented with the highest level of absenteeism at
443 The employee at tenure of 21 to 30 years presented with 198 of absenteeism rate
while the employees at 1 to 10 years presented with the rate of 30 The findings of the
research reflected tenure of 31 to 40 years to have presented with the lowest absenteeism
rate at 59 (n=878 days) This low absenteeism rate could be ascribed to the fact that
numbers of employees are reduced in this group or could also be commitment to their jobs
or could have higher ambition levels to aspire to higher posts
Van Der Westhuizen (2006136) and Rogers and Hertin (1993222) express tenure as work
experience that may be viewed as a predictor of employee productivity where seniority has
been found to be inversely related to absenteeism in terms of frequency and total number
of working-man days lost The public service employees enjoy security of tenure which may
contribute to the unacceptably high levels of absenteeism (Andrews 1997221ndash222
MINTRAC 20093)
The findings of the research reflect females as 75 of the total workforce (n=4010)
represented by 832 (n=12350) of the total working-man days lost (n=14840) The males
represent 25 of the total workforce (n=4010) and are reflected as absent at 168
(n=2490) of the total days of absence (n=14840)The absenteeism rate is very high for
females in this research Rogers and Hertin (199322) and Van Der Westhuizen (2006136)
suggest that women are absent from workplace more than men are Landstad et al (20011)
found that women cleaners who received preventive personnel support depicted a
reduction in absenteeism rate Hoxsey (2010562) claims that although women presented
with a high score of job satisfaction than men they maintained higher levels of
absenteeism MINTRAC (20094ndash8) found that gender moderates the age turnover
relationship Women are more likely to remain in their jobs the older they get than men do
The findings of the research reflect Africans as represented by 26 of the working
population and utilised 963 of the total working-man days lost due to sick leave It is
possible that the overall number of Africans influenced what seems to be a high level of
absenteeism at 963 Whites represented 03 of the working population and
absenteeism is reflected as 16 of the total working-man days lost Coloureds are
represented by 03 of the working-man population and absenteeism was recorded as 14
of the working-man days lost The Indians are represented by 01 of the total working
population and are reflected as 07 of the working-man days lost
The findings of the research reflect the salary range at level 11 to 12 utilised 25 working-
man days for sick leave salary level 7 to 8 which is the supervisory level utilised 346
working-man days lost salary level 3 to 4 which is the entry level of skilled workers utilised
353 working-man days lost The findings suggest management used fewer days of sick
leave in comparison to the supervisory level and entry skilled worker level
70
This can be ascribed to the fact that they are ultimately responsible for the institutionrsquos
effectiveness and productivity
The George Mukhari Hospital contributed 708 to the sample and reflected 771
absenteeism which is relatively low in comparison to the size of the contribution It could be
that processes and procedures of controlling leave of absence are in place The Tara Moross
Centre Hospital contributed 67 to the sample and reflected 93 absenteeism rate that is
high by 26
Professional nurses reflected a trend of high absence over the weekend including
Thursdays This could be a sign of burn out and extending the period of rest from possible
high workloads resulting from high vacancy rates (Gauteng Province annual report 20089)
Nyathi (200059) and the PSC (2002) found that employees are absent from work because
they want to prolong the weekend
53 CONCLUSIONS
The absenteeism rate is very high for females in this research The aging employee presents
with high levels of absenteeism through higher probabilities of becoming disabled for longer
periods The use it or lose it approach of the current system rewards the abuse of sick leave
as it is viewed as not being beneficial by the employees to act responsibly towards the use
of sick leave
The vacancy rate of 697 in the professional nurse category and the absence rate of 208
in 2008 in the four hospitals can only suggest inadequate levels of human resource for
effective efficient quality health care services at a high cost to the Province The nurses
may not be aware of the actual absenteeism or they under-estimate it The combination of
high registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery
Professional nurses and administration support staff have absented themselves from the
workplace predominantly on Mondays and Fridays It could be for various reasons ranging
from feelings of burn out to extending the weekend
The percentage of working-man days lost in relation to the total number of full-time
employees in the four hospitals is reflected as 488 which is very high as there is no
deterrent not to abuse sick leave in the public sector The findings of the research found a
significant correlation between the occupation and use of sick leave age and the use of sick
leave gender and use of sick leave and tenure and use of sick leave
71
The biggest hospital George Mukhari presented the lowest rate of absenteeism for its size
and complexity which reflects an empowered management The Tara Moross Centre
Hospital is the smallest hospital highly specialised and presented with high rate of
absenteeism for its contribution which may be a reflection on the skills of its management
or the type of health care service that is offered by the institution
The international norm of absenteeism is 3 The research established the absence rate at
488 The Gauteng Department of Health is held at ransom by the five trade unions it has
signed agreements with and that makes it difficult for managers to manage absenteeism
The practise of Gauteng Department of Health Head office to remove managers from
institutions when there is a labour unrest exacerbates the problem of managing
institutions
The findings of the research could not establish a representative reflection of race and
absenteeism as Indians Coloured and Whites were not represented in some institutionsrsquo
demographics
54 RECOMMENDATIONS
The White Paper on Transforming Public Service holds management responsible for
delivering specific levels of services and for obtaining value for money in wider utilising of
resources This strategy is to be translated into action The Gauteng Department of Health
should probably benefit by adopting the total absence management philosophy by
cultivating a culture that is not tolerant of high levels of absenteeism through building it in
as a key performance area of the performance of all managers and all employees The
current performance dimension system should lay explicit emphasis on this aspect
The re-engagement of knowledge based and professional retirees at reasonable
remuneration levels to reward their expertise may assist in reviving good work ethics by
mentoring the new and generally young recruits The retired professionals are currently
resisting the call for re-employment on a contract basis at entry level
The Gauteng Department of Health can encourage flexitime in terms of 58 or 68 to allow
the mature employee to remain within the system with the view to share their knowledge
and skills with the young employees who may be highly qualified but lack experience This
approach may deal with the need for adequate human resources for health care delivery at
reduced cost as two employees on flexitime basis can occupy one full-time employeersquos post
Managers should use the return-to-work counselling strategy to solicit feedback from the
employee about the actual absenteeism The counselling should be on a one-to-one basis
This approach may raise self-awareness to the employees in terms of the impact of the
employeersquos absence frothed workplace
72
Currently this intervention strategy is not adequately utilised for fear of confrontation with
labour representatives
Managers should have attendance policies in place effectively communicate policies to
employees adhere to policies and procedures and use absence control strategies
consistently This approach will minimise the feeling of injustice by employees Currently the
human resource unit is challenged by a high staff turnover due to promotions from the
human resource area a situation that creates a vacuum and lack of continuity weakening
the process of empowering line managers by human resource practitioners This high staff
turnover may be controlled through upgrading of the human resource salaries as the
salaries fall out of the occupation service dispensation (OSD)
Managers in the public service are expected to be responsible and accountable for their
portfolios including management of leave of absence and should not shift it to the human
resource unit as is currently the practice It should be possible to charge a manager as an
accomplice for failing to manage the absence of employees where there is no evidence of
corrective remedial action where it has been warranted The researcher takes cognisance of
the fact that the public service is highly unionised and this approach may trigger industrial
action
The employer needs to revive on the job in-service education and training as a way of
imparting institutional values such as attendance at the workplace in partnership with
recognised labour representatives through bilateral and multilateral forums and through
institutional skills development committee which should be representative of all
stakeholders with the view to promote stability in the workplace and indirectly enhance
productivity and reduce workplace absenteeism Currently the bilateral multilateral and
skills development committees are inactive in the institutions that were targeted and
management seems to be intimidated by the militant labour representatives
High levels of absenteeism among some occupational groups do suggest a need for an active
employee assistance programmes at all hospitals Employee wellness committees are
currently inactive There is a sporadic intervention approach at some institutions where
PILIR Committees are active Employee assistance programmes should be budgeted for as a
standing on-going programme in all hospitals There is a need for a thorough research as to
why absenteeism remains high in the public service and focus on absenteeism broadly
73
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African National Congress
Allen SG 1984 Trade union absenteeism and exit-voice Industrial and Labour Relations
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Auriacombe CJ 2001 Guidelines for drawing up research proposals and preparing
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Amin S Das J amp Goldstein M (eds) 2008 Are you being serviced Newtools measuring
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DevelopmentThe World Bank
Andrews Y 1997 The personnel function University of Pretoria Kagiso Tertiary
Babbie E 1992The practice of social research6th edition California Wadsworth
Bamford L Klein amp Engelbrecht B 1999 How to monitor and address absenteeism in
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KWIK-SKWIZ 25 Press Gang
Bangali A 2004 Are older workers genuine assets for economy Strategies and possibilities
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Barker F2007The South African labour market theory and practice5th edition Pretoria
Van Schaik
Bendix S 2000 Industrial relations in South Africa4th revised edition Lansdowne Juta
Bergdahl M 2001 How-Malrt minimises business with HR practices Human Resource
Development Gauteng College Regional Academy Leadership Journal 6
Breetzke A 2009 Managing absenteeism Available at httpwwwIrnetworkcoza
(Accessed on 05082009)
Brink H 1996 Fundamentals of research methodology for health care professionals
Kenwyn Juta
74
Brynard PA amp Hanekom SX 2005 Introduction to research in Public Administration and
related academic disciplines Pretoria Van Schaik
Burton JP Lee TW amp Holtom BC 2002The influence of motivation to attend and
organizational commitment on different types of absence of behavioursJournal of
Managerial Issues14 (2)
Buschak M Craven C amp Ledman R 1996 Managing absenteeism for productivity SAM
Advanced Management Journal6 (1)
Camp S amp Lambert EG 2005 The influence of organizational incentives on absenteeism
Sick leave use among correctional workers Available on
httpwwweascnoaagov(Accessed on22052009)
Canadian Nurses Association 2006 Trends in illness and injury ndashrelated absenteeism and
overtime among publicly employed registered nurses Canadian Nurses Association Ottawa
Available on httpwwwcna-aiicca (Accessed on 30032009)
Chaudhury Namp Hammer JS 2003Ghost doctors absenteeism in Bangladeshi health
facilitiesWorld Bank Policy Research Working Paper 3065 May Available
onhttpecoworldbankorg(Accessed on 10072011)
Charted Institute of Personnel and Development 2008Absence managementAnnual survey
report Charted Institute of Personnel and Development July Reference 4513 Available at
httpwwwcipdcouk (Accessed on 10072011)
Cloete JJ 2004South African public administration and management2ndimpression
Pretoria Van Schaik
Clark RL 2007The emergence of phased retirement economic implications and policy
concerns Ontario John Deutsch Institute for the study of economic policy
Dagmara S 2000Whorsquos minding the hospitals Absenteeism soars HampHN Hospitals amp
Health Networks 74 (4) April 14ndash143 Available at httpwwwoasisunisaacza(Accessed on
20072011)
Davey MMamp Cummings G 2009 Predictors of nurse absenteeism in hospitals a
systematic review Journal of Nursing Management 17 312ndash330 Available on httpO-
webebscohostcomoasisunisaacza (Accessed on 30072011)
Department for Public Service and Administration1997White paper on transforming public
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75
Department of Public Service and Administration 2007 Determination on working time in
the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Determination of leave of absence
in the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Policy and procedures on incapacity
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De Wit P 2006 Reasons for absenteeism in the Department of Defence Pretoria Tshwane
University of Technology
Du Toit Damp Van Der Waldt G 1998 Public management grassroots Cape Town Juta
Du Toit D Knipe A Van Niekerk D Van Der Waldt Gamp Doyle M 2001Service
excellence in governance Cape Town Heinemann
Du Toit D Bosch D Woolfrey D Godfrey S Rossouw T Christie S Cooper C Giles
G amp Bosch C 2003Labour relations law a comprehensive guide4thedition Durban
LexisNexis Butterworths
Erasmus B Swanepoel B Schenk H Van der Westhuizen EJamp Wessels JS 2005 South
African human resource management for the public service Pretoria Juta
European Foundation for the Improvement of Living and Working Conditions
(EFILWC)1997Preventing absenteeism at the workplace Ireland Office for Official
Publication on the European Committee
Fakie SA 2005Report on the Auditor-General on a performance audit of the management
of sick leave benefits at certain national and provincial departments Pretoria Department
Public Service and Administration (DPSA)
Ferguson T D Muedder Kamp Fitzgerald R M2001 The case of total absence
management and integrated benefitsHuman Resource Planning24 (3)
Finnemore M amp Van Rensburg R 2002 Contemporary labour relations Johannesburg
LexisNexis
Gaudine A amp Gregory C2010The accuracy of nursesrsquo estimates of their absenteeism
Journal of Nursing Management 18599ndash605
Gauteng Province 2007 Human Resource Development Strategy for Gauteng for Gauteng
maximizing human capital for shared growth Pretoria Government Printers
76
Gauteng Province 20089 Annual report Pretoria Government Printers
Gauteng Province 2010 Monitoring and Evaluation Policy FrameworkGauteng Provincial
Government Office of the Premier
Ghauri P Gronhaug Kamp Kristianslund I 1995 Research methods in business studies
England Prentice-Hall
Goldsmith Mamp Morgan H 2003 ldquoLeadership is a contact sport The ldquofollow up factorrdquo in
management development The 5th Annual Global Learning SummitResearched and
organised by SALVO 20ndash24Feb
Goldstein M2008Why measure service delivery Are you being serviced New tools for
measuring service deliveryEdited byAmin S Das Jamp Goldstein MWashington DCThe
International Bank for Reconstruction and DevelopmentThe World Bank
Griep RH Rotenberg L Chor D Toivanen SampLandsbergis P2010Beyond simple
approaches to studying the association between work characteristics and absenteeism
Combining the DCS and ERI modelsRoutledge Taylor amp Francis GroupWork ampStress 24 (2
April-June)179ndash195Available athttpwwwinformaworldcom (Accessed on 20072011)
Grogan J 2003 Workplace law 7 th edition Lansdowne Juta
Grogan J 2005 Dismissal discrimination and unfair labour practices Lansdowne Juta
Hirschfield RR Schmitt LPamp Bedeian GA2002 Job-content perceptions performance-
reward expectancies and absenteeism among low-wage public-sector clerical employees
Journal of Business and Psychology 16(4) Human Sciences Press Available on
rhirschfterryugaed(Accessed on 30032009)
Hoxsey D2010Are happy employees healthy employees Researching the effects of
employee engagement on absenteeismCanadian Public Administration53 (4) p551-
571Canada The Institute of Public Administration of Canada
Jacobs EJamp Roodt G 2011 The mediating effect of knowledge sharing between
organisational culture and turnover intentions of professional nursesSouth African Journal
of Information Management
Jankowitz E 1991Terminating for absenteeism practical labour management Rivonia IR
Data Publication 1(10)
Keese M2006 Live longer work longerDELSA Newsletter OECD Available at
httpwwwoecdorgelsemployment(Accessed on 10072011)
77
Lambert EG Camp SD Edwards Camp Saylor WG 2005 Here today gone tomorrow
back again the next day absenteeism and its antecedents among Federal Correctional
staffWashington DC Ohio
Landstad B Vinberg S Ivergard TT Gelin G ampEkholm J2001Change in pattern of
absenteeism as a result of workplace intervention for personnel support Ergonomics
001401391544 (1)
LexisNexis 2006Labour Law Reports July 1994ndashDec2006CumulativeIndex Durban
LexisNexis
LexisNexis 2007 Legislation and strategyLexisNexis (9)Durban Butterworths Available at
httpwwwmylexisnexiscoza (Accessed on 15072011)
Madibana LF 2010 Factors influencing absenteeism amongst professional nurses in
London Pretoria University of South Africa
Markussen S Rogeberg OJ amp Gaure S 2009 The anatomy of absenteeism IZA
Discussion Paper Series No 4240 June Bonn Institute for the Study of Labor
McCormick ET amp Ilgen D1985 Industrial and organizational psychology 8th edition New
Jersey Prentice-Hall
McGoldrick E amp Arrowsmith JJ 2001Discrimination by age the organizational response
Ageism in work and employment Edited by Glover IampMohamed Sterling Management
SeriesEngland University of Sterling
Mellor N Arnold Jamp Gelade G2009The effects of transformational leadership on
employees in four of UK public sector organisations Health and Safety Laboratory for the
Health and Safety Executive UK RR648 Research Report
MINTRAC 2009 Literature review on labour turnover and retention Available at
strategieswwwmintraccom (Accessed on 14042009)
Mouton J2005How to succeed in your Masterrsquos and Doctoral studies a South African guide
and resource book Pretoria Van Schaik
Munro L 2007 Absenteeism and presenteeism possible causes and solutions The South
African Radiographer45(1) Available onhttpsorsaorgza(Accessed on 10072011)
Nel PS Gerber PD Van Dyk PS Haasbroek GD Schultz HB Sono TampWerner A
2001 Human resource management5th edition New York Oxford
Nel PS Kirsten M Swanepoel BJ Erasmus BJampPoisant P 2008South African
employment relations theory and practice6th edition Pretoria Van Schaik
78
Nichols AampEvangelisti W2001 Fitness for work the effect of aging and the benefits of
exerciseSterling management series ageism in work and employmentEdited by Glover
LampMohamed B England University of Sterling
Nyathi MN 2000Factors contributing to absenteeism among nurses a management
perspective Pretoria University of South Africa
Patrick MN 2001Positive psychological functioning among civil servantsPretoria
University of South Africa
Paton N2010 Long-term absence hand in hand Occupational Health Reed Business
Information UK Reed Elsevier Available athttpebscohostcomoasisunisaacza
(Accessed on 10072011)
Parbhoo S2003 Why worry about absenteeism in the workplace CCMA PublicationCCMA
Mail July
Pierce K2009 The impact of absenteeism in the public service in the context of GEMS
Pretoria GEMS Government Employees Medical Scheme [lsquoslrsquo]
Public Service and Co-ordinating Bargaining Council (PSCBC) 2000Resolution 72000
Polit DF amp Hungler BP 1995 Nursing research principles and methods Philadelphia
Lippincott
Pousette A amp Hanse JJ 2002Job characteristics as predictors of ill-health and sickness
absenteeism in different occupational types-a multigroup structural equation modelling
approachNational Institute for working life TaylorampFrancisSweden Goteborg Available on
httpwwwtandfcouk (Accessed on 10072011)
Public Service Commission2002Sick leave trends in the Public Service Pretoria Public
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QUALSA Report 2009Policy procedure incapacity leave and ill-health retirement Steering
Committee QUALSA [rsquoslrsquo]
Reday-Mulvey G 2005Working beyond 60 key policies and practices in Europe New York
Palgrave Macmillan
Republic of South Africa 1995 Labour Relations Act 66 of 1995
Republic of South Africa 1997 Basic Conditions of Employment Act 75 of 1997
Republic of South Africa 2001 Public Service Regulation 2001
79
Republic of South Africa 2011 ldquoTowardsquality care for the patientrdquo National Core
Standards for Health Establishments in South Africa Pretoria Government Printers
Robbins SP amp Decenzo DA 2001 Fundamentals of management essential concepts and
applicationsNew Jersey Prentice Hall
Robbins SP Odendaal A amp Roodt G2004Organizationalbehaviour Global Southern
perspective 5th impression Cape Town Pearson
Rogers RE amp Hertin SR 1993Patterns of absenteeism among government employees
Public Personnel Management22 (2)Available at httpwwwquestiacom (Accessed on
10012009)
Serneels P Lindelow MampLievens T2008Qualitative research to prepare quantitative
analysis absenteeism among health workers in two African countriesAre you being
serviced New tools for measuring service deliveryEdited by Amin S Das
JampGoldsteinM2008 The International Bank for Reconstruction and DevelopmentThe
World Bank for Reconstruction and Development Washington D C The World Bank
Slabbert JA amp Swanepoel BJ 2001Introduction to employment relations
managementDurban Butterworths
South African Survey Millennium1999-2000 Johannesburg South African Institute of Race
Relations
Steers RMamp Rhodes SR 1978Major influences on employee attendance a process
model Journal of Applied Psychology63 (4)391-407
Oi-ling S2002Experience before and throughout the nursing careerPredictors of job
satisfaction and absenteeism in two samples of Hong Kong nursesJournal of Advanced
Nursing 40 (2)218ndash229 Available on httpwwwebscohostcomoasisunisaacza
(Accessed on 10072011)
Todd C2001Contract of employment Claremont Siber Ink
Tonya TW2001Minimizing absenteeism in the workplace strategies for nurse managers
Nursing Economics19 (2 MarApril) 53 3 Available at httpwwwoasisunisaacza
(Accessed on 14012009)
Tustin C 1994Industrial relations a psychological approach1st edition Halfway House
Southern Publishers
80
Unruh Jamp Strickland M2007 Nurse absenteeism and workload Negative effect on
restraint use incident reports and mortality JANORIGINAL RESEARCH Journal compilation
Florida Blackwell
Van der Westhuizen C 2006Work related attitudes as predictors of employee absenteeism
Pretoria University of South Africa
Venter R 2003 Labour relations in South AfricaRevised edition Cape Town Oxford
University Press
Viviane IJ 2011Absenteeism among women workers in industry85 IntrsquoLab Rev 248
(1962) Available at httpwwwHeinonlineorg(Accessed on 18052012)
Weeks KL 2004 Development and initial characteristics of a comprehensive survey on
workplace absenteeism Logan Utah State University Available on
httpwwwoasiscomunisaacza(Accessed on 14012009)
Welman JC amp Kruger SJ2001Research methodology for the business and administrative
sciences 2nd edition New York Oxford
Yende PM 2005 Utilising employee assistance programmes to reduce absenteeism in the
workplace JohannesburgUniversity of Johannesburg
81
ANNEXURES A B C
ANNEXURE A
PROCESS EVALUATION QUESTION COMPLIANCE
YESNO
ACTION PLAN
Retention and Reward -
leave
1 Are there complete and
accurate Z 1(Leave application
forms) forms on file
2 Have all application forms been
approved stamped and
registered
3 Have all forms been captured
on the Persal with the following
requirements
Supporting documents
A 10 day compulsory leave
processed within the annual
leave cycle Determination of
Leave
4 The remaining days are utilized
6 months from the end of the
leave cycle
5 Are there unutilized leave days
6 Has there been adequate
checking of leave reasons
Leave credits
Adherence to leave categories
(i)Normal ( ii) Incapacity
(iii) Injury on duty (iv) Maternity
(v)Adoption (vi) Family
responsibility
(vii) Office bearersshop stewards
and Casual Employees
7 Have work reasons been
provided for leave days
(Source Compiled by C S Ndhlovu 2012)
82
ANNEXURE B
Retention and
reward ndashsick leave
Evaluation Question Compliance YesNo Action Plan
1 Are there medical
certificates that have been
submitted to all medical
claims with the following
Specific illness stated
Supporting documents on
file
2 Has the 8 week rule for
36 days in a 3 year cycle
been adhered to
3 Are there complete
medical certificates for 3
days or more sick leave
days for normal sick leave
4 Are all other leave days
above 3 days utilized after
36 days treated as
temporary incapacity
leave
5 Are temporary
incapacity leave forms
submitted within 5 working
days after the first day of
absence
6Is there a register for
temporary incapacity
leave for 1 to 29 days lead
time for reporting leave
applications
7 Has the employer
approveddeclined the
leave application within 30
working days of receipt
(Source Compiled by C S Ndhlovu 2012)
83
ANNEXURE C
CHECK LIST
Is there a leave register in place for all leave applications
1 Is leave approved prior to the employee proceeding on leave
2 Area attendance registers maintained and up to date
3 Are periodic audits for leave carried out
4 Is there evidence of GSSCrsquos approval on leave applications
5 Are leave forms accurately captured on Persal
6 Are leave forms accurately completed by applicants
7 Is movement of leave forms monitored between the GSSC and institutions
8 How is rejected leave application dealt with
(Source Compiled by C S Ndhlovu 2012)
84
281 Measuring absenteeism 25
29 IMPACT OF WORKPLACE ABSENTEEISM 25
291 Cost to the institution 26
292 Low productivity 27
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM 27
2101 Effective communication 28
2102 Empowerment of managers 28
2103 Monitoring of workplace absenteeism 29
2104 Visits to facilities 30
2105 Incentive system 30
2106 Team support 31
2107 Return-to-work interviews 31
2108 Employee assistance programme (EAP) 32
2109 Occupational and safety committee 32
21010 Review committeehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip33
211 CONCLUSION 33
3 CHAPTER 3 METHODOLOGY IN RESEARCH 34
31 INTRODUCTION 34
32 RESEARCH DESIGN 34
321 Methodology 34
33 UNIT OF ANALYSIS 36
34 UNIT OF OBSERVATIONS 36
35 CONSTRUCT VALIDITY 36
36 ETHICAL CONSIDERATIONS 37
37 CONCLUSION 37
4 CHAPTER 4 INTERPRETATION AND ANALYSIS OF DATA 38
41 INTRODUCTION 38
42 THE STRUCTURE OF THE ORGANISATION 38
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY 39
44 COMPARISON OF HOSPITALS PERMANENT EMPLOYEES 40
441 The Tara Moross Centre Hospital 46
442 The Germiston Hospital 46
443 The ODI District Hospital 46
444 The George Mukhari Hospital 46
45 RESEARCH INTERPRETATION 47
451 Occupational groups in relation to absenteeism 49
4511 Doctors 50
4512 Professional nurses 51
4513 Staff nurses 51
VII
4514 Nursing assistants 51
4515 Finance officers 52
4516 Administration staff 52
4517 Administration support 52
452 Race in relation to absenteeism 57
4521 Africans 57
4522 Whites 57
4523 Coloureds 57
4524 Indians 58
453 Tenure range in relation to absenteeism 59
454 Salary range in relation to absenteeism 60
455 Age of full time employees in relation to absenteeism 61
456 Gender in relation to absenteeism 63
457 Week days in relation to occupational groups 64
46 CONCLUSION 66
5 CHAPTER 5 FINDINGS CONCLUSIONS AND RECOMMENDATIONS 67
51 INTRODUCTION 67
52 FINDINGS 67
53 CONCLUSIONS 71
54 RECOMMENDATIONS 72
BIBLIOGRAPHY 74
ANNEXURES A B Chelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip82
VIII
LIST OF FIGURES
FIGURE 21 CONCEPTUAL FRAMEWORK MODELhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
FIGURE 22 MODEL SPECIFICATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
FIGURE 41 INTEGRATED ORGANISATIONAL STRUCTUREhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip53
AS REPRESENTED BY THE HOSPITALS
FIGURE 44 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip58
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip60
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip61
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALShelliphelliphelliphelliphellip62
FIGURE 48 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip64
X
LIST OF TABLES
Table 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
Table 2 COMPARISONS OF NUMBERS OF ADMINISTRATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
AND SUPPORT STAFF IN THE DIFFERENT HOSPITALS
Table 3 GENDER COMPARISON IN DIFFERENT HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Table 4 COMPARISON OF TENURE OF SERVICE IN RELATION TOhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
ABSENTEEISM IN THE FOUR HOSPITALS
Table 5 COMPARISON OF THE OCCUPATIONAL GROUPShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip45
IN THE DIFFERENT HOSPITALS
Table 6 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip48
Table 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Table 8 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip54
(SALARY RANGE 1-12)
Table 9 AGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip55
Table 10 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Table 11 WEEK DAYS IN RELATION TO ABSENTEEISM INhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip65
THE FOUR HOSPITALS
Table 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphellip66
IX
CHAPTER 1
GENERAL INTRODUCTION
11 INTRODUCTION
The Gauteng Province is viewed as a province of opportunities by South Africans as well the
neighbouring countries such as Mozambique and Zimbabwe The impact of these
perceptions has placed a heavy demand on services including health provided within the
confines of the province the results being an increase in the workload of the employees
The indirect results of the increase in the workload have been unacceptably high levels of
absenteeism seemingly sub-standard levels of health care and high cost of delivering the
health care services Absenteeism poses a threat and can lead to the collapse of health care
services if absenteeism is poorly managed The research examines the management and
control of absenteeism in four out of thirty four hospitals that service the province The
hospitals that have been targeted for the research are ODI District Hospital Germiston
Hospital TARA Moross Centre Hospital and George Mukhari Hospital
This chapter explains the background and motivation for the research The research
highlights the problem statement which focuses on the effective management of
absenteeism The objectives of the study the research methodology and structure of the
research are explained The relevant literature review was consulted for the research The
key concepts that are used in the research are conceptually defined The research design is
a descriptive stratified random survey The data that were used were collected in three
phases the unit of analysis were the employees of the Gauteng Department of Health in the
four target hospitals and the unit of observations were observations of the employees of
the four hospitals The construct of validity was achieved through using a variety of data
collection methods Ethical considerations were taken into account during the research
process Limitations of the research were imposed by the uniqueness of each of the target
hospitals The structure of the research and the reference technique is explained in this
chapter The research on absenteeism in the Gauteng Department of Health is confined to
the period of 1 January 2008 to 31 December 2008 and focused on the working-man days
lost how absenteeism is managed and employee well-being and rehabilitation
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH
The Gauteng Department of Health received a qualified report in 2008 on the control of sick
leave A performance audit was conducted by the Public Service Commission (PSC) (2002
xvi) into the information required to effectively manage sick leave in the public service
1
The research on absenteeism in Gauteng Department of Health seeks to examine the extent
of workplace absenteeism in the ODI District Hospital which is in a transitional stage from
North West to the Gauteng Province The hospital falls under Tshwane Metropolitan
Municipality and is in Region C The Germiston Hospital falls under Ekurhuleni Metropolitan
Municipality in Region B TARA Moross Centre Hospital is in Region A under the
Johannesburg Metropolitan Municipality and George Mukhari Academic Hospital is Region C
under the Tshwane Metropolitan Municipality The research seeks to examine the degree of
compliance by the four hospitals with the recommendations of the performance audit of
management of sick leave in the light of the qualified report received by the Gauteng
Department of Health (Human Resources) in 20089
13 PROBLEM STATEMENT
The Gauteng Department of Health provides health care services as the core business of the
Department The Health care services are labour intensive and high levels of absenteeism by
its employees undermine the Departmental efforts to deliver quality health care to the
people of Gauteng The problem statement therefore is to examine to what extent the
effective management of absenteeism can enhance the effectiveness of the Gauteng
Department of Health
14 AIM AND OBJECTIVES OF THE RESEARCH
The aim and objectives of the research are explained in this section
141 AIM
The aim of the research is to determine how the effective management of absenteeism can
contribute to the effective health care of Gautengrsquos communities
142 Objectives
The objectives of the study are
to determine the impact of the variables such as age gender occupational category
and salary level on workplace absenteeism
to determine whether the correlation between absenteeism levels and tenure of
service does exist
to determine trends of workplace absenteeism in different employee categories and
to establish the different challenges confronting the different hospitals in
management and control of absenteeism in terms of size complexity and location
2
15 LITERATURE REVIEW
Various studies have been conducted to examine workplace absenteeism in different fields
in government and private institutions Van Der Westhuizen (200636) research focused on
high and low combinations of job involvement and organisational commitment The
outcome was not emphatic on the findings as predictors of the turnover and absenteeism
The research noted that women are more absent from the workplace than men De Wit
(2006) focused on the nature of absenteeism the impact of absenteeism on the
organisation reasons for and causes of absenteeism and measurement of absenteeism and
the findings were not able to find a high coefficient in the test sample
Camp and Lambert (20054) found that the use of sick leave as an incentive to reduce sick
leave by the employees under the Civil Service Retirement System (CSRS) led to a reduction
of absenteeism as a result of sick leave when compared with employees who functioned
under the conditions of the Federal Employees Retirement System (FERS) who within the
same company lost the unused sick leave when they retired
Ferguson Ferguson Muedder and Fitzgerald (200138) focused on the impact of
absenteeism and cost in terms of time lost in the Total Absence Management (TAM)
concept and found that the aging employee exposes institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods of
time
Serneels Lindelow and Lievens (2008210) claim absenteeism is high among employees in
the public sector in developing countries due to a lack of accountability and a lack of
punishment for transgression
The research seeks to determine the extent of the problem of workplace absenteeism its
impact and management in the identified hospitals It seeks to establish the relationship if
any between the various variables and absenteeism such as age occupation tenure salary
level gender and race
16 TERMINOLOGY
Key concepts that are used in the research are conceptually defined however a
comprehensive concept clarification will be done in chapter 2
Workplace absenteeism Workplace absenteeism is the absence of employee at the
workplace that is defined by Du Toit and Van Der Waldt in (1998139) as the place that the
institution makes available and where officials have to perform their work
3
Workplace forms part of the internal environment for public administration in the public
service Robbins Odendaal and Roodt (200415) define absenteeism as the failure of an
employee to report for work as scheduled regardless of the reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work According to
Venter (2003267) desertion occurs when the employee leaves the place of employment
without the intention to return to work
Employee An employee is defined as any person employed in terms of the Public Service
Act 1994 irrespective of rank or position (Public Service Act 1994 Subsection 15) Todd
(20011) refers to an employee as any person excluding an independent contractor who
works for another person and is entitled to be paid for it or who in any manner assists in
carrying on or conduct the business of the employer Bendix (2000123) defines an
employee as a person in a workplace except a ldquosenior managerial employeerdquo whose status
and contract of service grants the employee the authority to represent the employer in
interactions with the workplace forum to determine policy on behalf of the employer and
make decisions which might conflict with representation of workers at the workplace
Employer An employer as an individual person who may be the employer in legal terms as
well as the organisation which is responsible for implementing Public Service human
resource management policies (RSA 1997 Section 15)
Leave cycle The Public Service Act 1994 refers to the leave cycle as 36 months employment
with the same employer
Quality Is defined as getting the best results possible within the available resources (RSA
2011)
Standard Is a statement of an expected level of quality delivery A standard reflects the
ideal performance level of a health establishment in providing quality care (RSA 2011)
17 RESEARCH DESIGN AND METHODOLOGY
This section deals with the research design and methodology
171 Research design
Research design is the overall plan for relating the conceptual problem to relevant empirical
research It is a quantitative descriptive research that involves the systematic collection of
numerical information under conditions of considerable control (Polit amp Hungler 1994
24175)
4
The choice of the research design influences subsequent research activities such as
identifying the target subjects what data to collect and how they should be collected The
research design is a descriptive stratified random survey which is concerned with
characteristics of a specific population subject at a fixed point in time for comparative
purposes The focus is on a representative sample of the relevant population It is concerned
with the accuracy of the findings and their generalisability The survey is used to gain deeper
insight of the behaviour of employees with regards to motivation satisfaction and
grievances (Babbie 199289 Ghauri Gronhaug amp Kristianslund 199527 60 Brink 199611
6 Welman Kruger amp Mitchell 200152)
172 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services Four hospitals of the thirty four health care delivery institutions have been
identified for the research
Each hospital is unique in its character in terms of specialisation of health care delivery
service The four hospitals are located in Tshwane Johannesburg and Ekurhuleni
Metropolitan Municipalities The sample is a stratified random sampling which is composed
of various clearly recognisable non-overlapping sub-populations (strata) that differ from
one another mutually in terms of variables that are a combination of more than one
variable such as age sex income level or educational level The purpose is to ensure that
every part of the population (every stratum) is represented The members of a particular
stratum are homogeneous in the population at large The sample is representative of a
population with clearly distinguishable strata with a greater degree of certainty (Babbie
199267 Brynard amp Hanekom 200544 Ghauri et al 199578 Brink 1996138 Welman amp
Kruger 200155-56 Welman et al 201061 Polit and Hungler 199518) The data were
collected in three phases
The first phase of data collection was done through auditing of hard copies of identified
personnel files representing ten files per hospital and using the tool in annexure A amp B The
forty employeesrsquo profiles were accessed through the Human Resource Information
Management system (HRIM) located in the Gauteng Department of Health Head Office The
respective employeesrsquo profiles were handed over to the human resource manager in the
respective hospitals on the morning of the audit for the human resource practitioner to
draw out the hard copy files for auditing The characteristics of the individuals that were
identified for the first phase were males and females and the different race groups The
auditing of the files was for the complete working life of the employees and not confined to
2008 only Registers that are used by the human resource administration to control the
movement of the leave forms were inspected as evidence of the control system in place
5
The purpose of auditing the files is to gain insight into how leave in general was captured
managed and controlled by the hospitals The second phase of data collection was done
through structured interviews with the four human resource managers who were directly
accountable for management and control of leave of absence in general in the four
hospitals
A structured interview provides for a more organised approach and a more stable basis for
assessment of the different candidates (Erasmus Swanepoel Schenk Van der Westhuizen amp
Wessels 2005250) The structured interview was conducted using the tool in annexure C
Tara Moross Centre Hospital had been functioning without a manager in human resource
and the manager that was interviewed had been in the post for three months The human
resource practitioner who was at salary level 8 acting in the Assistant Directorrsquos post
(manager) was invited to join the manager and be part of the structured interview ODI
District Hospital had three human resource practitioners including the accounting officer at
level 8 and in an acting capacity
The third phase of data collection was through the Human Resource Information
Management (HRIM) This system used Personnel Remuneration Administration System
(PERSAL) to collect data Data in this system are categorised in salary level date of
appointment occupational category gender age in units of five race employing hospital
employment status in different categories such as session contract and full-time and the
different types of leave of absence
The research used primary and secondary data in analysing sick leave utilised by full time
employees in the identified hospitals for the period of 1 January to 31 December 2008 using
the Personnel Remuneration Administration System The total population sample was four
thousands and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range at level 1 to 12
The research used past events such as sick leave utilised by employees using secondary
data from Personnel Remuneration Administration System falling into the category of a
historical empirical research The interval scale of measurement was used in the
quantitative research and actual numbers are ordered with equal measurement between
each category (Brink 1996 149 Brynard amp Hanekom 2005 28-29 Mouton 2005
52100170)
6
173 Unit of analysis
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the research refers to observation of work attendance by
the employees of Gauteng Department of Health in the four hospitals
The observation deals with the historical events such as employees who have already
utilised sick leave in the workplace The subjects that are studied are the core health care
providers such as doctors nurses and support employees such as allied administration and
administration support (Mouton 200551-52 Welman et al 2001 52-53)
174 Unit of observations
The observations that are made are of health care workers and support teams in Tara
Hospital Germiston Hospital ODI Hospital and George Mukhari Hospitals The unit of
observations describes the characteristics of a large number of individual people such as
gender age salary range occupational category tenure of service and race in relation to
absenteeism in the workplace In the descriptive research the individual characteristics are
aggregated for the purpose of describing a larger group (Babbie 199292)
18 CONSTRUCT VALIDITY
Construct validity is concerned with the question what construct is the instrument actually
measuring(Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with the four accounting officers in leave management The third phase was collecting of
personnel data through the Persal system
19 ETHICAL CONSIDERATIONS
Ethical considerations included among other issues the protection of the unit of analysis and
unit of observations from discomfort and harm by not revealing information which can
cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity Anonymity is achieved
when the researcher cannot link a given response with a given respondent and reporting
aggregate data only When data are collected at one sitting and not over a period of time
makes it possible to achieve anonymity as the need for follow up is eliminated Subjects of
observations are selected for reasons directly related to the problem being studied as the
principle of justice
7
Confidentiality is about the researcherrsquos responsibility to protect all data gathered within
the scope of the research and shared only with people involved in the research (Babbie
1992465ndash466 Brink 199640ndash41 45)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous The interview was part of the actual audit
that was done as part of monitoring and evaluation that was in progress in the Department
of Health following a negative auditor generalrsquos report about management of leave in
general The managers were put at ease as they were given the check list afterwards for
self-monitoring for future self-auditing
The data that were collected through Personnel Remuneration Administration System
(Persal) identified employees through the Persal number and kept their identity anonymous
The data that were collected through the hard copy of employeesrsquo files were used to point
out areas of concern to the managers and the files did not leave the office of the manager
at the end of the process once more protecting the identity of the employee
110 LIMITATIONS OF THE RESEARCH
The research was conducted on four hospitals of different sizes specialisation and three
metropolitans with unique challenges The period of the research was confined to a
calendar year (2008) and not a financial year The focus was on absenteeism due to sick
leave of full time employees There is no distinction that is drawn between the working-man
days that are lost between shift and non-shift workers The findings may be different if all
absenteeism of employees at the time were considered for the research
111 STRUCTURE OF THE RESEARCH
Chapter 1 It provides a general introduction to the research It includes an introduction the
background and motivation for the research that provides the context the problem
statement and the significance of the research The key concepts are defined The research
design the method of data collection the sampling method data analysis and
interpretation limitations to the research are explained in this chapter
Chapter 2 This chapter considers the theoretical foundations concepts characteristics
theories approaches and classifications of workplace absenteeism Conceptual framework
of absenteeism predictors of absenteeism and various models of absenteeism are
explained Measures to control workplace absenteeism the impact of absenteeism in the
institution and management intervention strategies are explained
Chapter 3 It describes the research design different aspects of the research methods
applied and the data collection techniques used unit of analysis units of observations
construct validity and ethical considerations
8
Chapter 4 This chapter provides the organisational structure of the Gauteng Department of
Health comparisons of hospital employees different race groups of the four hospitals
gender comparisons in different hospitals and comparisons of the different occupational
groups It provides a short description of the target hospitals The research interpretation is
discussed in terms of the different occupational groups and absenteeism different races
and absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism
The week days absenteeism pattern and contributions by the four hospitals to absenteeism
are presented in this chapter
Chapter 5 It provides a discussion of the research evaluation of workplace absenteeism
findings recommendations and limitations
112 REFERENCE TECHNIQUE
The reference technique that is applied in the research involves all sources that have been
consulted while doing the research When legislation is used as a source of information
reference to the specific act is used
113 CONCLUSION
Chapter 1 provides a discussion on the background and motivation of the research problem
statement and the objectives The significance of the research in South African public
institutions and private institutions of other countries and the possible contribution of the
study are explored The terminology that is used in the research is contextualised for the
purpose of the research The research design and methodology are presented in this
chapter The units of analysis the units of observation construct validity ethical
considerations and limitations to the research are also presented in this chapter
The next chapter discusses the theories of absenteeism
9
CHAPTER 2
MANAGING ABSENTEEISM
21 INTRODUCTION
The Gauteng Department of Health is classified as a public institution whose existence is
justified on the grounds that it renders health care services to the public The health care
system is encouraged to develop delivery systems and practices that are in line with
international standards management practices that promote efficient and compassionate
delivery of services and ensures respect for human rights and accountability to the public
(African National Congress 199443-44) This objective can only be achieved if the resources
to provide such services are available The human resources are a vital factor for the health
care sector as it is labour intensive Public institutions such as the Gauteng Department of
Health are funded from public funds and if the human resources do not report for work
service delivery is compromised and the cost to the department in the form of salary
expenditure becomes exorbitant as the department must find replacement staff and pay
for overtime as well It is when all these factors are taken into consideration that workplace
absenteeism becomes a cause for concern for the Gauteng Department of Health
In this chapter absenteeism is discussed from a theoretical perspective and informed by
literature review The classification of workplace absenteeism theoretical perspective
definitions dimensions of employment relationship conceptual framework of absenteeism
structural model of absenteeism legislative framework that regulates the employment
relationship and intervention strategies to control workplace absenteeism are explored
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM
According to Viviane (20111) the term absenteeism was first used in Britain during the
First World War in dealing with employed persons It is during the times when production is
of pressing national importance that the absence of employees from the workplace is keenly
felt Absenteeism is considered a good barometer of staff morale an indirect measure of
employeesrsquo health and well-being and is found to be associated with health-related
absences from work Employees who are motivated and committed to their work and
employer have to be very sick before they book off sick (Griep Rotenberg Chor Toivanen amp
Landsbergis 2010179)
McCormick and Ilgen (198556-57) describe job attendance criteria as relating to a tendency
of employees to withdraw from or attend to their jobs The criteria identified were job
tenure occupational category absenteeism and tardiness According to Markussen
Rogeberg and Gaure (20096) employee characteristics such as age gender education and
occupation have a substantial impact on absence behaviour
10
Chaudhury and Hammer (20033) identified that medical skills and nursing skills are
marketable and greatly in demand Doctors and nurses used this opportunity to make
money and work as private health care providers as well as public health care providers
holding two jobs The absence is considered in terms of morning or afternoon absence by
these categories as they are viewed as having a great deal of discretion over where and
when to discharge their public responsibilities The criteria identified were job tenure
absenteeism and tardiness
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) refer to absenteeism
as non-attendance when an employee is scheduled to work The theoretical perspective of
absenteeism takes into account the physical and or psychological absence of the employee
from the workplace or work station at a time when the employee is contractually expected
to be at the workplace According to Andrews (199734-35) the behaviour and actions of
public officials are determined by specific ethical codes of conduct and it is assumed that
their actions are for the benefit of the communities that are serviced by the public officials
Social ethics focus on how the clients of the Department are treated and are therefore
concerned with the impact of decisions on people inside and outside the institution
individually and collectively
Grogan (2005237) states that employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
look for trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
2001 section F(c) In the public sector contractual employee benefits are modified by
collective agreements These benefits are material gains for the employees and have a
monetary value and a cost factor to the employer
The contract of employment often includes insured benefits such as incapacity ill health
and early retirement as the total package other than the remuneration for the time worked
as it is intended to attract retain and motivate employees (Breetzke 20091 Ferguson et al
200137 LexisNexis 2006670 LexisNexis 2007176 Markussen Rogeberg amp Gaure 20093
Tustin 199452) The policy on Determination on Leave of Absence requires a medical
certificate for sick leave of three or more days and for every sick leave day utilised when the
eight week rule has been transgressed (DPSA 2009 Section 14 subsection 147)
Political ideologies influence the work environment resulting in some areas being highly
unionised where unions are perceived to be capable of exerting control over the employer
and employee relations for the primary benefit of the employees
11
It is the work environment which is highly unionised that is characterised by high workplace
absenteeism (Andrews 199736 Breetzke 20091 Du Toit amp Van Der Waldt 1998170139
Tustin 199452) Allen (1984331) claims that union members might be absent more
frequently from the workplace than non-members because they face smaller penalties for
absenteeism According to Markussen et al (20095 21) workplace environments do have an
impact on absenteeism and are influenced by social interaction processes among
colleagues Absenteeism is affected by social norms Workplaces with high employee
turnover rate tend to have high absenteeism The turnover rate is defined on a quarterly
basis as Min (number of entries number of existing persons) divided by the number of
employees at the start of the quarter The Charted Institute of Personnel and Development
(CIPD) (200811) claim that the 2006 survey of absence management portrays the public
sector employees as less likely to be dismissed for reasons of workplace absenteeism A
report by the National Institute of Labour Studies (Tonya 20011) found the rate of
absenteeism increased among full-time employees from 2 4 to 25 within two years
The services that are provided by the Department of Health are divided into two distinct
categories Direct services are those services that are rendered to the clients who are
patients who receive medical treatment from the core employees usually referred to as line
functionaries Direct services can only become effective and efficient when supported by
the services of the support staff that provide indirect health care services When employees
do not present themselves for work when scheduled to work and do so on a regular basis
the situation becomes habitual absenteeism (Du Toit amp Van Der Waldt 199818) The
Gauteng Department of Healthrsquos core function is to provide health care services to the
people of Gauteng Province The provision of health care services is labour intensive and
requires large numbers of personnel for effective service delivery
The workplace which may be physical or virtual for the public service employees represent
the internal environment of the institution The employer who is represented by the
manager determines the workplace for employees
Rogers and Hertin (1993217) explain the Decision Model Theory as a conscious decision by
the employee to stay away from work or come to work based on which motivation is
stronger at that moment It is not based on the ability to come to work
Serneels et al (2008210) claim that absenteeism is rife in the public sector especially where
employees hold two jobs The actions of public officials in the performance of their duties
should be ethically justified as it impacts on the decisions of people within and without the
institution individually and collectively Tension and job insecurity in the workplace
manifests as absenteeism (Andrews 199733-137)
12
Frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased staff
morale and high cost to health care (Davey amp Cummings 2009312-313) It is suggested that
on average health care workers are likely to be absent from work as a result of illness or
injury rather than other occupations Dagmara (20002) states that absenteeism may be a
benchmark of what is happening in the hospital setting Absenteeism is defined as habitually
not coming to work when scheduled to It is an indicator of psychological medical or social
adjustment to work
Absenteeism is measured by frequency or duration of work-days missed Frequency
measures provide a reasonable index of voluntary absenteeism whereby each incidence or
episode of absence is counted regardless of the duration of absence It is defined as the
number of days absent over a given period of time Other measures used were total days
duration and percentage Duration measures provide an index of involuntary absenteeism
such as time lost index To assess absence duration the total number of days is tallied
regardless of the number of incidents (Davey amp Cummings 2009313) High workload is
identified as one of the factors that affect absenteeism rate among health care workers
(Oi-ling 20023)
Workplace absenteeism is costly for an institution in terms of lost working-man days hiring
of staff to close the shortage absent or sub-standard service delivery and poor quality of
services The total cost of employment risk approach is about the estimation of the possible
cost of any absent employee to an institution per hour The annual cost to the institutions
per employee is in terms of direct and indirect costs such as overtime low productivity and
a decline in morale among workers who are expected to cover for an absent employee
(Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
The public service employees enjoy security of tenure which may be a contributory factor
of absence from work without good cause This practice is fostered by the knowledge that
they cannot be easily dismissed from their jobs therefore have the belief it is right to stay
away from work Misuse of sick leave is considered to be an overriding problem in instances
where the employee does not uphold the standard of honesty and incorruptibility or these
values are not considered to be the corporate values and norms of the institution (Andrews
1997 221-222 MINTRAC 20093)
Bangali (20043-5) describes age function in the sociological theory as a natural
characteristic of human beings but also an integral aspect belonging to the structure of the
society The age definition in the labour market is influenced by the structural functionalism
The employees age is categorised in the workplace in terms of functions to be performed
be it physical or intellectual The age group of 35 years to 49 years old employees comprise
the largest age group in the labour market
13
The employees who are less than 20 years of age reflect the highest absenteeism rate while
employees above 50 years of age reflect a decrease in the absenteeism rate The
disadvantage of the older workers is that their disabilities last longer once they are injured
and are more likely to be absent as frequently and more likely to be injured than younger
workers Keese (20062) states that ageism is evident in the public service and describes the
age group 25 years to 49 years old as prime age Rogers and Hertin (1993219) found a
significant correlation between the use of sick leave and age Employees with advanced age
used comparatively more sick leave in comparison with the younger employees The
Canadian Nurses Association (20065) noted a reduction in workplace absenteeism rate
among nurses who are less than 45 years of age and an increase in the absenteeism rate
among nurses above 55 years of age
Camp and Lambert (20054) found that the use of sick leave retention as an incentive to
reduce use of sick leave by the employees under the Civil Service Retirement System (CSRS)
leads to a reduction of absenteeism as a result of sick leave compared to the Federal
Employees Retirement System (FERS) who within the same company lost the unused sick
leave when they retired The Employees Retirement System (FERS) applies the same
principle of handling sick leave as the Gauteng Department of Health in the sense that
unused sick leave is forfeited at the end of the three year cycle (DPSA 2009Section 14)
Unruh and Strickland (2007674) found that absenteeism from the workplace does
contribute to a vicious cycle of a negative work environment which leads to more
absenteeism and increased turnover Absenteeism has been found to be higher in
employees who are over 50 years of age and the phenomenon is attributed to age and
changing abilities that increase when work is performed on a full time basis Part-time
arrangements reduce absenteeism as well as the cost of paying for a senior employee even
if seniority is just in tenure Age has been linked to a negative turnover in an institution The
older employee is less likely to leave the organisation An institution is healthier for a spread
of ages Some organisations consider employees to be older in batches or cohorts of five
such as 40 years to 44 years up to 64 years (Nichols amp Evangelisti 2001285 McGoldrick amp
Arrowsmith 200184 MINTRAC 20093 Reday-Mulvey 200579-194)
MINTRAC (20094-8) states that gender moderates the age turnover relationship Women
are more likely to remain in their jobs the older they get than men do Turnover is
occasionally related or preceded by high workplace absenteeism The occupational category
is linked to skill levels and salary levels The lower skill employees are concentrated in the
lower skill occupations and easily replaceable
14
Hirschfield Schmitt and Bedeian (2002553) conducted a research on low-wage public
sector clerical employees and found that those employees who perceived limited
performance-reward expectancies were likely to be absent more often The link between
skilled employees and absenteeism suggested that employees may have utilised
absenteeism as a means of compensating for perceived workplace contributions not
extrinsically rewarded
According to Gaudine and Gregory (2010599) the Canadian Institute for Health Information
(2007) found that absenteeism was a problem among health care workers in comparison to
other employees in other sectors Unruh et al (2007673) found the combination of high
registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery Markussen et al (200921) claim that the type of occupation an
employee is engaged in has an impact on absenteeism
221 Classification of absenteeism
The employees of the Gauteng province and their attendance at work are the focal point of
the province in relation to service delivery that is customer focused Health care services are
labour intensive and require employees to be at work when scheduled to do so (Gauteng
Province 201015) Workplace absenteeism can present in different forms and levels as a
result of a combination of variables (Andrews 19975 Breetzke 20091) McCormick and
Ilgen (198557) and Davey and Cummings (2009313) classify absenteeism as voluntary
when the absence is based on the conscious decision by the health care giver to withhold
contractual services The absence is uncertified unauthorised and unexcused while
involuntary absenteeism occurs for reasons beyond the control of the health care giver
such as illness injury or family responsibility Employers are challenged with the task of
differentiating between the absence due to elective workplace absence and absence due to
illness incapacity The differentiation is based on whether the illness incapacity is validated
by a legitimate medical certificate in terms of the prescript of section 23 of the Basic
Conditions of Employment Act (BCEA) 75 of 1997 (RSA 1997)
222 Definition of key concepts
Concepts are defined for common understanding in the context of the study
Workplace absenteeism Workplace absenteeism is absence of the employee at the
workplace that is defined by Du Toit and Van Der Waldt (1998139) as the place that the
institution makes available and where officials have to perform their work It forms part of
the internal environment for public administration in the public service Bamford Klein and
Engelbrecht (199911) refer to absenteeism as employees taking time off that has not been
scheduled
15
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) claim that
absenteeism is non-attendance when an employee is scheduled to work The European
Foundation (199711) views absenteeism as temporary or permanent incapacity for work as
a result of sickness or infirmity According to Robbins Odendaal amp Roodt (200415)
absenteeism is a failure of an employee to report for work as scheduled regardless of the
reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work The employee
should actually intimate expressly or by implication the intention not to return to work
According to Venter (2003267) desertion occurs when the employee leaves the place of
employment without the intention to return to work
Employee The Basic Conditions of Employment Act no 75 of 1997 Section 1 (a) (RSA 1997)
and Todd (20011) refers to an employee as any person excluding an independent
contractor who works for another person and is entitled to be paid for it or who in any
manner assists in carrying on or conduct the business of the employer The courts use the
control test which identified employees on the basis that they were part of the employer
organisation Bendix (2000123) claims that an employee is a person in a workplace except a
senior managerial employee whose status and contract of service grants the employee the
authority to represent the employer in interactions with the workplace forum to determine
policy on behalf of the employer and make decisions which might conflict with
representation of employees at the workplace Du Toit Bosch Woolfrey Godfrey Rossouw
Christie Cooper Giles and Bosch (200368) state that an employee is a person who works
for a single employer in a permanent fulltime capacity is subject to the supervision of the
employer and receives regular monthly or weekly remuneration and is obliged during
working hours to place his or her productive capacity at the employerrsquos prescribed disposal
Employer
Bendix (2000129) defines an employer as any person except an independent contractor
working for another person or the State and who receives remuneration or any manner
assists in carrying out or conducting the business of an employer DPSA (PILIR) (20094)
states that an employer is the Head of Department or a designated office which will be
responsible for the handling and investigation of incapacity leave applications and ill- health
retirement applications
16
23 EMPLOYMENT RELATIONSHIPS
The employment relationship is about balancing the simultaneous convergent and divergent
interests of the employer and the employee in a regulated manner with the aim of getting
the work of the institution done According to Erasmus et al (2005442) an employment
relationship exists when an individual is employed by someone else to be available to work
for that person in exchange for some remuneration It is through this employment
relationship that reciprocal rights and obligations are created between the employer and
the employee The employment relationship is conflictual in nature (Andrews 199736) The
employees through this relationship are enabled to gain access to the rights and benefits
associated with their employment The Labour Relations Act no 66 of 1995 (RSA 1995)
regulates the management of the conflict in the employment relationship through dispute
resolution structures such as the Commission for Conciliation Mediation and Arbitration
(CCMA) Labour Court and Labour Appeal Court when internal processes fail to resolve the
conflict The employment relationship can be traditional or typical and terms and conditions
of service of employment are regulated by collective agreements This is a tacit
acknowledgement of the existence of a typical employment relation
231 Employment relationship as a multi-dimensional phenomenon
Industrial relations and human resource management are bound together by the
employment relationship through labour employer and industrial relation triangle The
employment relationship is characterised by various dimensions as is the case in a broader
society The dimensions are economic legal individual collective and psycho-social (Grogan
200347)
2311 Economic dimensions
The economic dimension arises through the provision of labour by the employee in the form
of skill knowledge energy abilities and productive time to the employer in exchange for
remuneration Barker (200779) states that a reduction in working hours increases the
hourly cost of production in a unit unless there is a commensurate increase in productivity
The economic dimension is highly regulated The contract of employment includes insured
benefits such as incapacity ill health and early retirement The tendering of services by the
employees is a prerequisite to the employeersquos right to claim remuneration (Grogan
200347) According to LexisNexis (2007176) and the Public Service Regulations 2001
Section E E1 the actual contractual benefits are modified by collective agreements in the
public service sector Employee benefits are material gains for employees that have
monetary value and are a cost factor to the employer The Public Service Regulation 2001
Section F (a) states that the Head of Department shall promote economic and efficient use
of resource to improve the functioning of the public service (RSA 2001)
17
According to Ferguson et al (200137) and Erasmus et al (2005380) employee benefits are
the total compensation package other than the pay for time worked offered to employees
either partially or completely funded by the employer contributions In 2006 about R19
billion was lost on account of absenteeism from sick leave (LexisNexis 2006670 Patrick
2001 17)
Employee benefits are intended to attract retain and motivate employees Some of the
benefits offered to employees are mandated by law such as minimum leave provision as
contained in the Basic Conditions of Employment Act 75 of 1997 and Resolution 72000 of
the Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
2312 Legal dimension
The Labour Relations Act 66 of 1995 Section 3 of Schedule 8 requires that while employees
should be protected from arbitrary action employers are entitled to satisfactory conduct
and work performance from their employees The legal framework provides for the
regulatory requirements for human resource management in the working environment
Grogan (200347) and Grogan (2005120) view the employment relationship as formalised
by a legally binding agreement which is the contract The contract is regulated by specific
laws and formal rules with all the inherent rights and responsibilities to the employer and
the employee In terms of the employment contract one of the responsibilities of the
employee is to render service to the employer at specified agreed upon time except where
the employer has authorised the absence of the employee from the workplace Employees
have a fundamental duty to render services and the employer has a right to expect the
employees to tender such services A basic element of the duty to render service is that the
employee must be at the workplace at the specified agreed upon times unless there is
adequate reason to be absent Bendix (2000120) states that a contract is subject to the
terms and conditions of collective agreements The contract is subject to automatic changes
whenever a new collective agreement is in place The contract and its inherent benefits are
breached by elective absence behaviour of the employee The legal dimension has an
impact on the individual dimension
2313 Individual dimension
The employee enters into a working contract with the employer on an individual basis The
contents of the contract are subject to the Basic Conditions of the Employment Act 75 of
1997 The terms and conditions of employment in the public service are subject to collective
bargaining and collective agreements which influence the employment contract in the
Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
18
The contract of employment is entered into between the employer and the employee under
the supervision of the employer and for remuneration purposes
2314 Collective dimension
According to Slabbert and Swanepoel (20017) the collective dimension of the employment
relationship refers to the organised group aspect of the employment relationship which is
between labour as a group and employers and or their representative public sector
institutions The collective dimension aspect of employment relationship pertains to
legislation relating to bargaining dispute resolution and industrial action
2315 Psycho-social dimension
The psycho-social dimension of the employment relationship represents the unexpressed
needs and expectations of the employer and employees It refers to behaviour in the public
sector institutions within the context of the collective dimension (Davey amp Cumming 2009
313 Erasmus et al (2005442) The Public Service Regulation 2001 Section B states that the
Head of Department shall determine the working time of employees and take into
consideration their personal circumstances which have a social dimension (RSA 2001)
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM
Davey and Cummings (2009322) amalgamated two theories to create a theoretical
framework with the premise that employee attendance is based on two factors the ability
to attend and motivation to attend The theoretical framework focuses on individual work
ethics demographics and from the work environment Some form of absenteeism may be
difficult to prove in a situation where the employer has two or more operational stations or
the employee occasionally operates from a virtual office The duty to render service is
breached by the employee when the employee is physically present and mentally absent as
would be the case of sleeping on duty Workplace absenteeism is multi-dimensional such as
changes in the work environment that overburden the coping mechanism As a result of this
approach a multi-dimensional framework of absenteeism clouds the causative factors of
absenteeism (Breetzke 20091 Patrick 200124 Tustin 199452)
19
FIGURE 21 CONCEPTUAL FRAMEWORK MODEL
(Adapted from Davey amp Cummings 2009320)
The conceptual model uses individual predictors of absenteeism such as age salary level
tenure race gender occupation educational level job satisfaction and organisational
commitment ability to attend and pressure to attend Organisational commitment is
described as having loyalty to the organisation identifying with its core values and
influences whether or not an employee feels it is appropriate to take unauthorised
unscheduled absences Group level absenteeism is not viewed as a predictor of individual
absenteeism (Davey amp Cummings 2009320 Lambert Camp Edward amp Saylor 20058-9)
25 PREDICTORS OF ABSENTEEISM
Oi-ling (20023-6) claims that in Hong Kong there were 47500 work days lost as a result of
employee sick leave in 1998 and suggests the examining of stress levels for nurses in
different cultures to enable a fuller understanding of the predictors of absenteeism as
different cultures accept some predictors and some reject the same reasons for illness
20
Personal characteristics
2Employee value Job
expectation
1Job situation scopejob level role
stress work amp group size leadership
style
4 Satisfaction
with job situation
3 Ability to attend Illness and accidents transport problems
6 Attendance motivation
7 Employee
attendance
5 Pressure to attend work
incentiveswork ethics
Education
salary
tenure age
gender race
Occupation
Lambert et al (20058) claim that organisational commitment job satisfaction job stress
health issues and personal characteristics correlate as regards employee absenteeism The
findings of the research by Van Der Westhuizen (2006136) focused on high and low
combination of job involvement and organisational commitment and the outcome was
emphatic on the turnover as predictor of absenteeism
According to Unruh and Strickland (2007674) absenteeism from the workplace contributes
to a vicious cycle of a negative work environment which leads to more absenteeism and
increased turnover McCormick and Ilgen (198556) describe turnover as dysfunctional
where an employee wishes to leave the institution and the employer prefers to retain the
individual and is functional where the employee wishes to leave the institution and the
employer accepts the termination of services by the employee
De Wit (2006) focused on attitudes towards job factors that had an influence on
absenteeism and was not able to find a high coefficient in the test sample McGoldrick and
Arrowsmith (20018) claim that an organisation is healthier for a spread of ages Ferguson et
al (200138) state that aging employees expose organisations to high levels of absenteeism
through higher probabilities of becoming disabled for longer periods
Oi-ling (20023-6) and Patrick (200124) found that gender and age among other predictors
of absenteeism have a significant influence on absenteeism Age was positively related to
well-being in managers and negatively related to absence frequency among hospital
employees Older employees were shown to have higher responsibility at work and utilised
minimal days for sick leave Female employees were observed to have utilised more
absences than males
Andrews (1997221-222) and MINTRAC (20093-8) state that gender moderates the age
turnover relationship Women are more likely to remain in their jobs the older they get than
men do Turnover is occasionally related or preceded by high workplace absenteeism The
occupational category is linked to skill levels and salary levels The lower skill employees are
concentrated in the lower skill occupations and easily replaceable Public service employees
enjoy security of tenure which maybe a contributory cause of absence from work without
good cause a practice that is encouraged by the knowledge that they cannot be easily
dismissed from their jobs therefore have the belief it is right to stay away from work
Rogers and Hertin (1993217-222) found a correlation between the use of sick leave and
age Employees with advanced age comparatively used more sick leave in comparison with
younger employees The level of education seems to have influenced the use of sick leave
where the lower level categories of employees were found to have a higher level of
absenteeism than higher educated individuals
21
Robbins et al (200447) state that married women employees have fewer absences and
undergo fewer job turnovers Rogers and Hertin (1993222) express tenure as work
experience in years that is viewed as a predictor of employee productivity where seniority
has been found to be inversely related to absenteeism in terms of frequency and total
number of work-man days lost The level of education was found to have an influence
where the lower category of employees was found to have higher levels of absenteeism
than higher educated employees Jacobs and Roodt (2011425) and Davey and Cummings
(2009320) state that an organisational culture in hospitals can contribute towards lower
turnover as the turnover rate is a predictor of absenteeism The process can be facilitated
by promoting knowledge sharing that can provide opportunities that may meet employee
expectations
Pousette and Hanse (2002229-231) suggest that theories that make predictions about
antecedents to ill health and sickness absence make the assumption that the relationships
are the same in different occupations Reduced job autonomy is suggested to be associated
with higher sickness absence The occupation specific model is used in order to identify the
variance in the patterns in terms of occupation-groups Davey and Cummings (2009320)
found that turnover was significantly related to absenteeism
Hirschfield et al (2002553) conducted a research on low-wage public sector clerical
employees and found that those employees who perceived limited performance-reward
expectancies were likely to be absent more often The link between skilled employees and
absenteeism suggested that employees may have utilised absenteeism as a means of
compensating for perceived workplace contributions not extrinsically rewarded Unruh et al
(2007674) found that absenteeism from the workplace does contribute to a vicious cycle of
a negative work environment which leads to more absenteeism and increased turnover
26 A MULTI-GROUP INVARIANCE MODEL
A multi-group invariance structural model represents different types of occupations such as
industrial blue-collar workers industrial collar workers elderly care workers and child
health care workers The focus of this model relates to the extent to which a model that is
assumed to include a general population also includes sub-populations such as different
occupational types The occupation specific model allows different relationships between
variables in different occupations The specific model approach allows for identification of
the most common reasons for absenteeism and early retirement in the workplace and was
successfully utilised in Sweden A common model proposes that absenteeism is a
behavioural response to dissatisfaction with the job (Pousette amp Hanse 2002230-244)
Nyathi (200059) found that professional nurses were absent from work because they
wanted to prolong their weekends
22
Davey and Cummings (2009313) argue that on average health care employees are more
likely to be absent from work as a result of illness or injury than other occupations Paton
(20104) acknowledges that line managers are the fundamental building blocks for reducing
absenteeism and must be provided with the tools to manage absence The absence rate at
3 is considered very high and must be vigorously and progressively managed
FIGURE 22 MODEL SPECIFICATION
(Adapted from Pousette amp Hanse 2002232)
Pousette and Hanse (2002232-245) make the assumption that low job autonomy and low
skill discretion deprive the employees of the opportunity to handle work obstacles and
regulate workload to a manageable level implying a negative relationship to workload has
an impact on absenteeism rate Patrick (200123-24) states that changes in the working
conditions overburden the coping mechanism Work-related stress can lead to deteriorating
physical and emotional well-being The work object is the distinguishing quality between
occupations in the different occupational groups whereby the blue-collar employee works
with things that are tangible such as materials and machines whereas the white-collar
employee is knowledge based employee who is working with data
23
Structural Model
W L Work load
I H Ill-Health
S A Sickness absenteeism
S D Skills discretion
(autonomy)
27 CATASTROPHIC MODEL (CAT)
According to Buschak Craven and Ledman (199628) the catastrophic model (CAT) caters for
major illness that keeps the employee away from work for extended periods of time This
model is similar to short and long term incapacity sick leave whereby the employee has
exhausted the normal sick leave of 36 days which is catered for by DPSA section 14 (RSA
2009)
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM
The general behaviour and actions of public officials are determined by specific ethical
codes of conduct and the unethical conduct results in effective administration and
unsatisfactory service delivery (Andrews 199733) Effective control of workplace
absenteeism requires an absenteeism policy to be in place management to establish the
magnitude and patterns of absenteeism and raise awareness about the consequences of
breaking these rules (Bamford Klein amp Engelbrecht 19992)
The Determination on Leave of Absence in the Public Service (DPSA 2009 section 14 141)
the Public Service Co-ordinating Bargaining Council Resolution (PSCBC 72000) Davey and
Cummings (2009313) and DPSA (PILIR) 2009 section 3 31 state that an employee is
entitled to 36 working days sick leave with full pay in a three year cycle with the same
employer Any unused leave credits shall lapse at the end of the three year cycle The
employee is expected to utilise and manage the normal leave circumspectly The employee
who chooses to utilise sick leave days must submit a medical certificate for every occasion
of three or more sick leave days utilised The medical certificate must be issued and signed
by a practitioner or persons who are registered with the Professional Councils established
by the Act of Parliament Incapacity leave is additional sick leave granted conditionally at the
employerrsquos discretion An employee who has exhausted the normal sick leave during the
prescribed sick leave cycle and who requires to be absent from work due to a temporary
incapacity may apply for temporary incapacity leave with full pay According to the Policy
and Procedures on Incapacity Leave for Ill-Health Retirement (PILIR) (DPSA 2009) an
employer is not required to pay an employee if the employee has been absent from work
for more than two consecutive days or more than two occasions during an eight week
period and on request does not produce a medical certificate
The Public Service Regulations 2001 F (c) holds the manager accountable when an
employee abuses sick leave (RSA 2001) According to Parbhoo (20036) and Nel et al
(2008145) the doctor patient confidentiality is not above reach to the employment
relationship by suggesting that the employer can question the authenticity or contents of
the medical certificate if there is sufficient reason to do so within the confines of
confidentiality
24
According to Breetzke (20092) South African employees are challenged by global trends to
seek mechanisms to deal with excessive absenteeism at the workplace The Charted
Institute of Personnel and Development (CIPD) (200811) claims that the 2006 survey
showed that public sector employees are less likely to be disciplined or dismissed for
reasons of workplace absenteeism
281 Measuring absenteeism
Measuring absenteeism in the workplace enables the employer to determine the extent and
nature of the problem Absenteeism is measured using two measures total time lost and
absence frequency Nel et al (2001584) In institutions total time lost is determined for
every group of employees and category of absence such as sick absence authorised and
unauthorised absence The recognised international norm is 3 Institutions challenged
whether to accept the international norm as the given or strive to bring workplace
absenteeism down in the interest of quality and quantity of service delivery The total time
lost index is calculated as the Total number of days lost due to absence over the period
multiplied by a thousand and divided by the average number of employees multiplied by a
thousand and divided by an average number of employees multiplied by total work-days
over the period (Amin Das amp Goldstein 20086 Breetzke 20094 Nel et al (2001584)
According to Nel et al (2001584) high workplace absenteeism rate is suggestive of incidence
that is of short duration and therefore more disruptive to the operational plans of an
institution as prior knowledge of pending workplace absenteeism allows for forward
planning and reduction of the costs associated with absenteeism The absence frequency
rate is calculated as Number of absence incidence over the period divided by the average
number of employees employed over the period (Breetzke 20094 Nel et al 2001254)
29 IMPACT OF WORKPLACE ABSENTEEISM
Lambert et al (20056 36) claim that absenteeism has adverse effects on those employees
who are good attenders as they are shuffled around to fill in the positions of absent
employees Organisations suffer the detrimental effects and consequences of employee
absenteeism Management expend valuable time to modify employee assignments to
respond to absences When employees who are in management or in highly specialised job
assignments report sick the work assigned to them remains undone because their positions
remain vacated and the work remains for them to complete The responsibility and
accountability these employees are entrusted with may influence less use of sick leave by
them
The White Paper on Transforming Public Service Delivery (DPSA 1997) holds management
responsible for the specific level of resources and for obtaining value for money in these
resources
25
Madibana (201022) found in the research about absenteeism amongst nurses that the high
rate of absence had an impact in the reduction of quality care rendered by nurses
291 Cost to the institution
Andrews (19978221) describes an institution as the process through which activities are
grouped logically into the distinct areas and assigned to managers It results in the logical
grouping of activities in a department Workplace absenteeism influences the cost of an
institution which influences the quality of the product or service that is rendered by the
institution Employee attendance is a vital element for managing productivity of any
institution and its individual members The unfilled posts reflect the absence of public
health care employees and do not absorb budget resources for salary and upkeep of
facilities Absent personnel still receive their salaries If public servants are not on the job
the expenditures embodied in them do not reach their beneficiaries (Chaudhury amp Hammer
20032 Lambert et al 20055) The cost is direct in terms of salary expenditure or indirect in
terms of staff replacement
Ferguson et al (200138) argue that the cost of employment risk approach is about
estimation of the possible cost of any absent employee to an institution per hour per day
Robbins Odendaal and Roodt (200415) estimate that absenteeism costs South African
institutions millions of rand a year in decreased efficiency and increased benefit payments
Fakie (20053) notes that sick leave costs the national government 15 of the total basic
salary expenditure for the National Department of Health from 1 January 2001 to December
31 2003
The South African Chamber of Business (SACOB) (Patrick 200117) acknowledges that in
2006 about R19 billion were lost on account of absenteeism resulting from sick leave
According to the European Foundation (19977) United Kingdom lost 11 billion pounds in
1994 Germany lost 30 5 billion EUC in 1993 and Belgium lost 24 billion EUC in 1995
Breetzke (20092) describes indirect costs as hidden costs harder to measure and may
include economic value of lost productivity Indirect costs relate to loss of production that
may arise by engaging some expects to provide service in the field where they are closing
the staff shortage gap Rogers and Hertin (19939) and the European Foundation (19978)
view the individual employee and his or her dependants in a social dimension aspect as
exposed to reduced income as a result of extended workplace absenteeism related to ill
health where long term incapacity is involved
The total cost of employment risk approach is about estimation of the possible cost of any
absent employee to an institution per hour The cost may be direct and indirect such as
overtime low productivity and a decline in morale among workers who are expected to
cover for an absent employee (Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
26
292 Low productivity
According to Jankowitz (19911) high levels of absenteeism are disruptive to production
where operators are interdependent or where levels of service have to be maintained
Buschak Craven and Ledman (199626) argue that absenteeism generates costs for the
institution and productivity problems put an unreasonable burden on the rest of the
employees who are at work An absent employee be it physical or psychological remains an
unproductive employee Absenteeism viewed from an employerrsquos perspective is regarded as
a problem that impacts negatively on service delivery while the employeesrsquo believe their
mere presence in the workplace is being productive
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM
Managing workplace absenteeism remains a challenge for all employers and the Gauteng
Department of Health has not been spared the challenges faced by other institutions as it
provides health care services to the citizens of Gauteng The provision of good quality health
care is vital for the development of human capital The implications of declining quantity
and quality of care is grave when the human capital equity and efficiency which are the
cornerstones of health care service delivery are threatened by employees who are not at
work when expected to be (Gauteng Province 200711) Misuse of sick leave is considered to
be an overriding problem in instances where the employee does not uphold the standard of
honesty and incorruptibility or these values are not considered to be the corporate values of
the institution (Andrews 1997 221-222 MINTRAC 20093)
According to Grogan (2005237) employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
identify trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
Part V Section F(c) (RSA 2001) The workplace can be a virtual office Workplace
absenteeism is perceived to be high in unionised workplace environments where unions are
perceived to be capable of exerting control over the employer and employee relations for
the primary benefit of the employees In the public sector contractual employee benefits
are modified by collective agreements
Public service managers are to focus towards results achievement and be accountable for
the performance of their institutions (Gauteng Province 201023) Workplace absenteeism
can be reduced by tightening up policies and procedures relating to control of absenteeism
and intensifying monitoring processes on absent employees
27
According to Cloete (2004290-297) public institutions are to provide quality goods and
services The public institutions require an appropriate infrastructure to enable them to
perform their core functions (Bamford et al 19991 Buschak et al 1996 28 Munro
200722)
2101 Effective communication
According to Oi-ling (200212) managers should alter the psycho-social environment at work
and cultivate an institutional climate that supports staff and facilitate effective
communication Institutions should raise awareness to employees of their rights and
responsibilities regarding leave of absence and the consequences of abusing it (Bamford et
al 19992) The policies should be clearly written and well communicated to all employees
and be readily available and accessible In a highly unionised environment these policies are
debated in bilateral or multi-lateral forums between management or employer
representatives and labour representatives The human resource practitioners must conduct
periodic in-house training on these policies for management and employees to facilitate
uniform interpretation and enforce compliance by all stakeholders The policies must be
couched in simple understandable language that is free of legal terms for ease of
comprehension by all users The policies on workplace absenteeism must be explicit of
actions to be taken when policies have been violated or employees are aggrieved
2102 Empowerment of managers
Workplace absenteeism is multi-dimensional requiring inputs from all related fields
Managers require on-going support and training on issues that relate to absenteeism at the
workplace The human resource unit works with managers to establish performance
standards training of employees on the importance of execution and assists managers to
focus on continuous improvements superior execution and employee empowerment
(Bergdahl 20019 RSA 2011)
The labour relations unit supports the training of managers on grievance handling bilateral
and multi-lateral encounters with employee representatives with employee education
issues specific to workplace absenteeism The Charted Institute of Personnel and
Development (CIPD) (200835) reported that 70 of managers in the public service have
been trained in workplace absenteeism handling
Employment relationships bind human resource and industrial relations together with the
common objective of achieving institutional goals and labour peace Managers focus on
managing the institution for productivity at the lowest possible cost by providing quality
care therefore reducing the risk of litigation control of absence from work and work
efficiency
28
It is the delays in dealing with issues that give the employees the feeling of being unfairly
treated and demoralised Consistency in upholding these processes is essential for creation
of a stable employment relationship while any deviation from the set processes give rise to
worker unfriendly environment (Bergdahl 20118-9)
2103 Monitoring of workplace absenteeism
The manager is expected to keep accurate records for all leave of absence taken by
employees In terms of the management of ill-health absencersquos the manager has to ensure
that the eight week rule is observed whereby the employee who has been absent from
work on more than two occasions during an eight- week period must regardless of the
duration of the sickness or injury submit a medical certificate (RSA Part V section F (b)
DPSA 2009 section 14 148) Pierce (200921) believes that management of human capital
may be achieved through the integration of employee benefits employee assistance
programmes and human capital
Monitoring of absenteeism is a human resource function that gets lost in the competing
functions that are carried out by human resource practitioners High levels of absenteeism
are an indication of poor management and or conflict within the employment relationship
The methods to monitor workplace absenteeism vary from one institution to the other It is
human resource management that establishes common guidelines that are used by
management to monitor workplace absenteeism In monitoring absenteeism the manager
considers each employeersquos case on its merit
The manager focuses on certain aspects of the case such as failure to call in on the day of
absence pattern of use of sick leave before or after holidays and sick absence occurring on
certain days of the week or month Monitoring systems to monitor and record attendance
of work are put in place to assist management with simple accurate functional data that
facilitates informed decision- taking at management level The employees of the province
and their attendance at work become the focal point of the province in relation to service
delivery Peer pressure monitoring comes from colleagues at the same facility Hierarchical
monitoring of employees by management may lead to more attendance for fear of being
discovered (Chaudhury amp Hammer 200319 Gauteng Province 201015) A health care
service institution may use Health Information System and Personnel and Salary
Administration System (PERSAL) among others to ease the burden of the monitoring
process All these tools combined are useful in gathering administrative data for
management
29
2104 Visits to facilities
The role of human resource at institutional level is to support and guide management as
well as monitor compliance issues Workplace absenteeism remains a key focus area
because of its impact on the budget of an organisation Unscheduled facility visits are
conducted with the view to audit workplace absenteeism The audit is to be done in line
with the auditor-general or internal risk managementrsquos approach to encourage consistency
A check list that is used is prepared by human resource practitioners and institutions are
familiar with A human resource accounting officer of the institution should be involved
when an audit is done
The institution must have evidence available of sporadic visits to employees who have been
identified as having developed absenteeism patterns with the view to rule out elective
absence The European Foundation (199713) and Munro (200722) state that ill- health is
the main reason for workplace absenteeism Employees who present with ill- health are
generally and frequently more absent from work than the healthy ones The authors also
observe that not all employee assistance programmes aimed at reducing workplace
absenteeism have an effect on the ill-health of the employees which render the
unscheduled visit to the employees vital to see where the caring employer could be of
assistance
2105 Incentive system
According to Buschak et al (199628) the catastrophic model (CAT) caters for major illness
that keeps the employee away from work for extended periods of time This model is similar
to short and long term incapacity sick leave which is catered for by PILIR subsection 73
(DPSA 2009) The managers require special training for successful implementation of the
policy The paid time off model (PTO) has hidden benefits incentives for employees not to
use unnecessary sick days which are then paid for at retirement The research by Lambert
and Camp (20054) compares the Civil Service Retirement System (CSRS) and the Federal
Employees Retirement System (FERS) and showed that in the final analysis and when
novelty wore off workplace absenteeism was not necessarily reduced by the incentive
system
Management should use the strategy to raise awareness about responsible utilisation of sick
leave through workshops about PILIR and the eight week rule It should show the benefits
of good sick leave management when employees are challenged with temporary or
permanent incapacity leave
The use it or lose it approach of the current system reward the abuse of sick leave as it is
viewed as not being beneficial by the employees to act responsible towards the use of sick
leave There is no deterrent not to abuse sick leave in the public sector
30
2106 Team support
Institutions value team effort over individual achievement Operational competencies are
viewed as essential Managers encourage effective communication among team members
motivating others and the development of problem-solving skills Managers through the
team development effort encourage nurturing and transmitting of the institutional culture
Institutional culture refers to a system of shared meaning within an organisation that
determines how employees behave in the workplace Culture and people are like glue that
ensures that institutional standards are upheld Individuals become units that form the
team and conversations at work are encouraged to strengthen team work knowledge
transfer and productivity (Bergdahl 20018-10 Goldsmith amp Morgan 200378 Robbins amp
Decenzo 2001174)
2107 Return-to-work interviews
According to Paton (20101ndash5) a phased return-to-work data management and remote
services are among the approaches employers may use to manage workplace absenteeism
The intervention can involve use of Information Technology systems and telephone
discussions Good absence management is about good people management The return-to-
work interviews provide management with the opportunity to get to know the employee
better and for the employee to substantiate his or her case The employee is afforded
privacy during the sessions which should happen as soon as the employee comes back to
work The key success in this strategy is unthreatening follow ups that are done A multi-
faceted approach is used to get people back to work such as phoning maintaining regular
contact and taking medical advice
The Charted Institute of Personnel Development Annual Report (200835) reported 90 of
public services that use the strategy and 77 use the risk assessment to aid return- to-
work The manager should have private counselling sessions with the employee as soon as
the employee returns to work These sessions provide the employee with the opportunity to
put his or her case across and for the employer to get a first-hand opportunity to asses if the
employee is fit enough to come back to work The employer has to make the employee
aware of the status of the meeting that it is formal and proceedings are recorded The
employer is to keep accurate records of all counselling sessions
31
2108 Employee assistance programme (EAP)
DPSA (PILIR2009) prescribes that the PILIR committee promotes EAP in the workplace and
each institution to establish a committee The PILIR committee consists of a labour relations
officer an EAP practitioner a health practitioner an employee wellness practitioner and
any other relevant practitioner who is co-opted on a needs basis The purpose of the
committee is to manage short and long term incapacity which is sick leave utilised after the
employee has exhausted the 36 days normal sick leave in a three year cycle The short term
incapacity sick leave is of longer than three days and less than 29 days and long term
incapacity is sick leave longer than 29 days The short spells of sick leave become a concern
when there is evidence of a pattern of abuse It is a call for the manager to intervene Every
organisation should provide EAP that is funded by the employer to the employees A health
risk manager is used by the employees who are expected to honour referrals and stay with
the programme until such time that there is evidence of recovery failure by the employee
to accept the programme should attract a disciplinary process
According to Mellor Arnold and Gelade (20098) the amount of support that followers
receive from their transformational leader or co-worker may help reduce levels of absence
by making the workplace a more pleasant place to be and perhaps by helping the person
find solutions to work out family conflict or other problems that produce absence Landstad
et al (20011) suggest that the individuals in the preventive intervention group who were
less than 42 years of age total absence due to sickness decreased The change was obvious
to the cleaners who had a previous history of high absence due to sickness The Charted
Institute of Personnel Development (200836) focused on working-man days lost
management of absenteeism employee well-being and employee rehabilitation The skilled
employees were reported as 12 who were using rehabilitation programmes Yende
(200535) and Fakie (200517) state that EAP despite having been around since 1996 for the
National Department of Health has not actually been managed and utilised to its full extent
whereby if fully utilised would assist in the management of employee workplace
absenteeism
2109 Occupational and safety committee
The focus of this committee is on the provision of a safe working environment by the
employer (RSA Part VI section D 2001) It monitors issues of compliance and adopts the
employee advocacy role The committee consists of all the major stakeholders such as
employee representatives labour representatives that represent employees in the
institution on issues of safety at the workplace In the context of the Gauteng Department
of Health the committee engages with the labour representatives and employer
representatives at bilateral and provincial multi-lateral scheduled meetings
32
According to Du Toit and Van Der Waldt (1998139) the International Labour Organisation
recommends creation and maintaining of a pleasant work environment in order to improve
productivity The environment must stimulate the employee to ensure efficiency and
effectiveness
21010 Review committee
This structure is essential when dealing with incapacity leave It is composed of
management human resource practitioner employee representative labour relations
officer employee wellness and any adhoc person needed in terms of the case under
discussion (DPSA PILIR 2009) The employee reserves the right to lodge a grievance about
the outcome of his incapacity request if it is negative The role of the committee is to
provide a transparent forum reduce hostility against management and to protect the rights
of the employee through involvement of the employee representative
211 CONCLUSION
The literature review that has been consulted explores the workplace absenteeism and its
impact on the institution The employment relationships represent a triangle that consists of
the employer the employee and the industrial environment The relationship is multi-
dimensional and highly regulated with built in mechanisms to handle conflict in the
workplace Conflict is inherent to the employment relationship and structures and
mechanisms such as bargaining councils the Commission for Conciliation Mediation and
Arbitration and Labour Courts are structures for recourse The theory of absenteeism and
employment relationship were explored Management intervention strategies were
explained Controlling absenteeism in the workplace begins with a sound absenteeism
policy that is incorporated into an employee induction programme Communicating and
educating the employees about the absenteeism policy takes the centre stage in the
employment relationship Vigilant monitoring of workplace absenteeism is the responsibility
of the manager closest to the employee such as the supervisor Workplace attendance
problems of employees can be handled using sound judgement keeping accurate
attendance records and administering the policy fairly and consistently
Chapter 3 will collect data which will confirm or negate the literature review that has been
explored in chapter 2
33
CHAPTER 3
METHODOLOGY OF THE RESEARCH
31 INTRODUCTION
Chapter 3 focuses on the methodology used to determine the absenteeism in the four
hospitals of the Gauteng Department of Health The research design and the methodology
that have been used to collect data are discussed below The data are collected in terms of
the characteristics of the stratified random sample such as absenteeism of the different
occupational categories gender age tenure of service race groups and salary
32 RESEARCH DESIGN
A research design is the overall plan for relating the conceptual problem to relevant
empirical research It is a quantitative descriptive research that involves the systematic
collection of numerical information under conditions of considerable control The choice of
the research design influences subsequent research activities such as identifying the target
subjects what data to collect and how they should be collected The research design is a
descriptive survey which is concerned with characteristics of a specific population subject at
a fixed point in time for comparative purposes The focus is on a representative sample of
the relevant population It is concerned with the accuracy of the findings and their
generalisability The survey is used to understand the behaviour of employees with regards
to motivation satisfaction and grievances (Babbie 1992 89 Ghauri et al 199527 60 Brink
199611 Welman et al 200152)
321 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services The four hospitals that have been targeted for the study of absenteeism are Tara
Moross Centre Hospital in Region A under the Johannesburg Metropolitan Municipality
Germiston Regional Hospital which is in Region B under Ekurhuleni Metropolitan
Municipality ODI District Hospital in Region C under Tshwane Metropolitan Municipality
and George Mukhari Academic Hospital in Region C under Tshwane Metropolitan
Municipality Each hospital is unique in its character in terms of specialisation of health care
delivery service The sample is a stratified random sampling which is composed of various
clearly recognisable non-overlapping sub-populations (strata) that differ from one another
in terms of variables that are a combination of more than one variable such as age sex
income level or educational level The purpose is to ensure that every part of the population
(every stratum) is represented The members of a particular stratum are homogeneous with
the population at large
34
The sample is representative of a population with clearly distinguishable strata with a
greater degree of certainty (Babbie 19927 Brink 1996138 Brynard amp Hanekom 2005 44
Ghauri et al 199578 Welman amp Kruger 200155-56 Polit amp Hungler 199518)
The data were collected in three phases The first phase of data collection was done through
auditing of hard copies of identified personnel files encomprising ten files per hospital and
using the tools in annexure A and B The forty employeesrsquo profiles were accessed through
the Human Resource Information System (HRIM) located in the Gauteng Department of
Health Head Office The respective employeesrsquo profiles were handed over to the human
resource manager in the respective hospital on the morning of the audit for the human
resource practitioner to draw out the hard copy files for auditing The characteristics of the
individuals that were identified for the first phase were males and females as well as
representatives from the different race groups The auditing of the files were for the
complete working life of the employees and not only confined to 2008 calendar year
Registers that are used by human resource administration to control the movement of the
leave form were inspected as evidence of the control system in place The purpose of
auditing the files was to gain insight into how leave in general was captured managed and
controlled by the hospitals
The second phase of data collection were done through structured interviews with four
human resource managers who were directly accountable for management and control of
leave of absence in general in the four hospitals A structured interview provides for a more
organised approach and a more stable basis for assessment of the different candidates
(Erasmus et al 2005250) The structured interview was conducted using the tool in
annexure C Tara Moross Centre Hospital had been functioning without a human resource
manager and the manager that was interviewed had been in the post for three months The
human resource practitioner who was at salary level 8 and acting in the Assistant Directorrsquos
post (manager level 9) was invited to join the manager and be part of the structured
interview ODI District Hospital had three human resource practitioners including the
accounting officer at level 8 in an acting capacity The third phase of data collection was
through the Human Resource Information Management System (HRIM) This system uses
the Personnel Remuneration Administration System (PERSAL) to collect data Data in this
system is categorised in characteristics such as salary level date of appointment
occupational category gender age in units of five race employing hospital employment
status in different sub-categories such as session contract and full-time and the different
types of leave of absence The continuous sick leave of four to five days was excluded from
processing and focus was laid on sporadic days to the start and end of a weekend
35
The research used secondary data in analysing sick leave utilised by full time employees in
the identified hospitals for the period of 1 January to 31 December of 2008 using Persal The
total population sample was four thousand and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range from level 1 to
12 The research used past events such as sick leave utilised by employees using secondary
data from Persal falling into the category of historical empirical study The interval scale of
measurement was used in the quantitative research and actual numbers are ordered with
equal measurement between each category (Brink 1996 149 Brynard amp Hanekom 200528-
29 Mouton 200552100170)
33 UNIT OF ANALYSIS
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the study refers to observation of work attendance by the
employees of Gauteng Department of Health in the four hospitals The observation deals
with the historical events as employees have already utilised the sick leave in the workplace
The subjects that are studied are the core health care providers such as doctors nurses and
support employees such as allied administration and administration support (Mouton 2005
51-52 Welman et al 2001 52-53)
34 UNIT OF OBSERVATIONS
The observations that are made are of health care employees and support teams in Tara
Moross Centre Hospital Germiston Hospital ODI Hospital and George Mukhari Hospital
and describe the characteristics of a large number of individual people such as sex age
salary range occupational category tenure of service and race in relation to absenteeism in
the workplace The descriptive study and the individual characteristics are aggregated for
the purpose of describing a larger group (Babbie 199292)
35 CONSTRUCT VALIDITY
Construct validity is concerned with the question What construct is the instrument actually
measuring (Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with four of the accounting officers in the leave managements The third phase was
collecting of personnel data through the Persal system
36
36 ETHICAL CONSIDERATIONS
Ethical considerations will include amongst other issues such as the protection of the units
of analysis and units of observations from discomfort and harm by not revealing
information which can cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity
Anonymity is achieved when the researcher cannot link a given response with a given
respondent and reporting aggregate data only When data are collected at one sitting and
not over a period of time makes it possible to achieve anonymity as the need for follow up is
eliminated Subjects of observations are selected for reasons directly related to the problem
being studied as the principle of justice Confidentiality is about the researcherrsquos
responsibility to protect all data gathered within the scope of the study and shared only
with people involved in the research (Babbie 1992465ndash466 Brink 199640ndash41 45 Polit amp
Hungler 1995 31-36)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous to the researcher The interview was part
of the actual audit that was done as part of monitoring and evaluation that was in progress
in the Department of Health following a negative auditor generalrsquos report about
management of leave in general The managers were put at ease as they were given the
checklist afterwards for self-monitoring and for future self-auditing
The data that were collected through Persal identified employees through the Persal
number and kept their identities anonymous The data that were collected through the hard
copy of employeesrsquo files were used to point out areas of concern to the managers and the
files did not leave the office of the manager at the end of the process once more protecting
the identity of the employee
37 CONCLUSION
This chapter dealt with the research design which is the overall plan for relating the
conceptual problem to relevant empirical research The methodology used a stratified
random sample which is composed of various clearly recognisable non-overlapping sub-
populations that differ from one another in terms of variables that are a combination of
more than one variable The data collection was done through three phases The unit of
analysis refers to the persons who are studied The unit of observations are health care
workers and support teams in the four identified hospitals The construct validity used a
multi-trait multi-method approach Ethical considerations include among other issues
protection of the unit of analysis and the unit of observations from discomfort and harm
Chapter 4 discusses the analysis and interpretation of the data gathered in chapter 3
37
CHAPTER 4
INTERPRETATION AND ANALYSIS OF DATA
41 INTRODUCTION
This chapter focuses on the research analysis and interpretation of data gathered on
workplace absenteeism in the Department of Health of the Gauteng Province It seeks to
identify differences or similarities in the leave trends in the 2008 calendar year between the
four identified hospitals chosen for the study in the Municipality of Tshwane Ekurhuleni and
Johannesburg The year 2008 was chosen as a second year in the leave cycle that started in
2007 The type of leave of absence is interpreted as a collective that does not specify the
type of sickness or illness or it being acute or chronic Workplace absenteeism is absence of
the employee at the workplace that is defined by Du Toit and Van Der Waldt (1998139) as
the place that the institution makes available and where officials have to perform their
work It forms part of the internal environment for public administration in the public
service Direct public administration is directly concerned with the rendering of services to
the citizens of the country
Chapter 4 discusses the study of workplace absenteeism in the four identified institutions
namely Tara Moross Centre Hospital Germiston Hospital ODI District Hospital and George
Mukhari Hospital In this research the following factors will be examined the organisational
structure and absenteeism of the different workforce categories such as medical and
nursing professionals administrative staff allied professionals and various categories of the
general assistants workforce and their relation to absenteeism in the institution
42 THE STRUCTURE OF THE ORGANISATION
The Gauteng Province is one of the nine provinces of South Africa In 2005 the auditor-
general conducted an audit of sick leave performance in six national departments and the
Gauteng Province was among those that were omitted from the audit The research focuses
on the Gauteng Department of Health (GDoH) whose core function is to provide health care
services to the people of Gauteng The provision of health care services is labour intensive
and requires large numbers of personnel for effective service delivery The GDoH is serviced
by thirty-four hospitals four of which have been identified for the study of management of
sick leave The employee attendance to work is essential to the achievements of the
Departmental goals The Determination on Leave of Absence determines the leave policy for
public service employees (DPSA 2009) The employees of GDoH represent the staff
component as reflected in the organisational structure of the department
38
The Gauteng Department of Health (GDoH) provides the basic health services to the people
of Gauteng who as internal or out-patients are clients or consumers of the services referred
to as line functions Public administration services rely heavily on support services such as
the personnel department that renders support to line functions that provide the actual
service of patient care Support services are considered as indirect public administration
services and essential in efficient public service delivery Workplace absenteeism has a
negative impact on productivity Employees of the Gauteng Department of Health and their
attendance to work are the focal point of the Province in terms of effective health care
service delivery that is customer focused
Political ideologies as those espoused by labour representatives are part of the external
factors in the workplace environment that consequently have an impact on public
administration and management and workplace attendance by employees (Du Toit amp Van
Der Waldt 1998139170)
FIGURE 41 INTERGRATED ORGANISATIONAL STRUCTURE
(Adapted from Gauteng Department of Health organisational structure 2010)
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY
The Gauteng Provincial Government has made a commitment to its people to account for
the delivery of services as its electoral mandate This commitment will be achieved only
when monitoring and evaluation of its performance is enforced by all Gauteng Department
of Health service providers
39
MEC
HOD
COP
Senior Exec
CD HAST CD Health program
Senior Exc
CD Tshwane
CD JHBWest
CFO
Manage Account
SENIOR CORPORATE
HRM amp LR
GenderampDisability
The Gauteng Governmentrsquos commitment to provision of health care services to all its
citizens is demonstrated by the decentralisation of management of service delivery with the
view to foster accountability increase efficiency and accountability (ANC 199419ndash20
Goldstein 200815) The interpretation of the analysed data takes the sector performance
approach into consideration when the interpretation of absence is across all the
occupational groups for the 2008 calendar year (Gauteng Province 201015)
44 COMPARISON OF HOSPITALSPERMANENT EMPLOYEES
Gauteng employees are counted at 51475 from the Personnel Salary Administration System
(PERSAL) as of March 2008 The population from the four chosen hospitals has been
counted at 4010 reflecting 8 of the total population The different groups of employees
were identified as Africans represented as n=3902 Whites as n=51 Indians as n=14 and
Coloureds as n=43
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALS
(Source Compiled by the researcher C S Ndhlovu 2012)
Figure 42 reflects the racial split percentage of the workforce (n=4010) of the hospitals
The population from the four hospitals has been counted as 4010 reflecting 8 (n=51475)
of the total working population for Gauteng Department of Health as from 1 January to 31
December 2008 The different groups of employees were identified as Africans represented
by 973 (n=3902) Whites as 13 (n=51) Indians as 03 (n=14) and Coloureds as 11
(n=43) The George Mukhari Hospital has a female dominated workforce at 739 (n= 2097)
in a total workforce of n=2836
40
Population n=4010
Africans 973
Whites 13
Coloureds 11
Indians 03
TABLE 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALS
RACE TARA HOSPITAL GERMISTON GEORGE
MUKHARI
ODI TOTAL
Africans 227 367 2836 472 3902
Whites 23 24 3 1 51
Coloureds 5 37 0 1 43
Indians 13 1 0 0 14
Population 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 1 focuses on the distribution of race and the population of the total workforce The
geographical area of the hospital determines the demographics and the tendency of some
groups being poorly represented or totally absent The research focused on permanent
employees of the four hospitals The George Mukhari Hospital employees are reflected as
7079 (n=2839) ODI Hospital as 1182 (n=474) Germiston Hospital as 1069 (n=429)
and Tara Moross Centre Hospital as 668 (n=268) of the total working population Tara
Moross Centre and Germiston Hospitals are located in cosmopolitan areas while the George
Mukhari and the ODI Hospitals are in rural and semirural areas The positioning of the latter
hospitals may account for the high African workforce
41
TABLE 2 COMPARISONS OF NUMBERS OF ADMINISTRATION AND SUPPORT STAFF IN THE
DIFFERENT HOSPITALS
OCCUPATIONAL
GROUP
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Administration
staff
48 60 297 61 466
Administration
support
103 140 719 133 1095
TOTAL 151 200 1016 194 1561
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 2 presents the administration employees and the administration support in the four
hospitals Tara Moross Centre Hospital is represented by 3179 (n=151) of administration
and 6822 (n=103) administration support The George Mukhari Hospital has the highest
representation by the administration support at 7077 (n=1016) The high representation
of the administration support staff at George Mukhari Hospital could be partly because of
the semi-rural environment A semi-rural environment is usually characterised by poverty
which may have a negative influence on opportunities to access education and skills
Doctors and nurses are highly marketable because of the educational levels and skills that
are lucrative and enable this group to be highly mobile geographically (Chaudhury amp
Hammer 20033)
42
TABLE 3 GENDER COMPARISON IN DIFFERENT HOSPITALS
GROUPS HOSPITALS MALE FEMALE POPULATION
Africans Tara 83 144 227
Germiston 52 315 367
George Mukhari 739 2097 2836
ODI 109 363 472
TOTAL 983 2919 3902
Whites Tara 5 18 23
Germiston 5 19 24
George Mukhari 3 0 3
ODI 1 0 1
TOTAL 14 37 51
Indians Tara 1 12 13
Germiston 0 1 1
George Mukhari 0 0 0
ODI 0 0 0
TOTAL 1 13 14
Coloureds Tara 1 4 5
Germiston 6 31 37
George Mukhari 0 0 0
ODI 1 0 1
TOTAL
GRAND TOTAL
8
1006
35
3004
43
4010
(Source Compiled by C S Ndhlovu 2012)
Table 3 focuses on gender distribution in the population of the research represented by
males and females in the different racial groups
43
The geographical area of the hospital determines the demographics and the tendency of
some groups being poorly represented or totally absent The males of the different hospitals
account for 251 (n=1006) while the females account for 749 (n=3004)
The George Mukhari Hospital has a female dominated workforce at 7394 (n=2097) out of
a total workforce of n=2836 White male employees are represented by 011 (n=3) against
the total workforce of the hospital (n=2839) There are no Indians and nor any Coloured
employees African males are represented by 2603 (n=739) The same hospital has no
white female employees no Indians no Coloureds and 7395 (n=2097) African females
The table reflects a predominantly African female workforce The hospital is situated in a
rural setting and this may have an impact on the vast difference in the gender
representation
The Tara Moross Centre and Germiston Hospitals are located in cosmopolitan areas They
have 187 (n=5) and 1117 (n=5) White male employees respectively and 672 (n=18)
and 443 (n=19) female employees respectively Tara Moross Centre Hospital has 4 48
(n=12) female Indian employees while Germiston Hospital has only 024 (n=1) Germiston
Hospital has 723 (n=31) female Coloured employees while Tara Moross Centre has 150
(n=4) The core function of the various hospitals may have influenced the gender
distribution
TABLE 4 COMPARISON OF TENURE OF SERVICE IN RELATION TO ABSENTEEISM IN THE
FOUR HOSPITALS
TENURE IN YEARS DAYS OF ABSENCE PERCENTAGE
1ndash10 4451 30
11ndash20 6577 443
21ndash30 2934 198
31ndash40 878 59
TOTAL 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 4 reflects the level of tenure of the total workforce from 1 year to 40 years of service
Tenure of 11 years to 20 years of service reflects 443 (n=6577) utilisation of leave of
absence and remains the highest rate of absenteeism followed by tenure of 1 to 10 years of
service at a 30 absenteeism rate
44
TABLE 5 COMPARISON OF THE OCCUPATIONAL GROUPS IN THE DIFFERENT HOSPITALS
OCCUPATIONAL
CATEGORIES
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Doctors 12 12 354 19 397
Professional
nurse
47 81 548 109 785
Staff nurse 15 53 358 56 482
Nurse assistant 16 50 308 55 429
Social worker 4 4 8 3 19
Occupational
therapists
4 0 15 1 20
Radiographer 0 3 27 6 36
Clinical
Psychologists
4 0 10 2 16
Physiotherapists 0 1 9 1 11
Dieticians 0 0 5 3 8
Finance 4 11 59 9 83
Speech
therapists
0 0 5 1 6
Pharmacists 2 9 36 5 52
Dentists 0 0 0 3 3
Technicians 2 5 51 6 64
Librarian 1 0 0 0 1
Security 6 0 30 1 37
Administration
and support
151 200 1016 194 1561
TOTAL 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 5 reflects a great difference in terms of number of occupational groups in the four
hospitals
45
The core function and the size of the hospital seems to have a bearing on how many
occupational categories of employees are to be found in that hospital as well as the actual
figures of these categories The George Mukhari Hospital is an academic hospital that trains
medical doctors This hospital has 1247 (n=354) doctors in a staff establishment of
n=2839 Tara Moross Centre has 448 (n=12) in a staff establishment of n=268 Germiston
has 280 (n=12) in a staff establishment of n=429 and ODI District hospital has 401
(n=19) in a staff establishment of n=474 This trend of vast differences in figures
represented by the occupational groups is evident in the category of professional nurses
where George Mukhari Hospital reflects 1931 (n= 548) nurses Tara Moross Centre is
represented by 1754 (n=47) Germiston by 1889 (n=81) and ODI District hospital by
23 (n=109) The impact of absenteeism is pronounced when viewed against the level of
facility capacity in terms of human resources of the core occupational groups
441 The Tara Moross Centre Hospital
Tara Moross Centre Hospital is a speciality psychiatric hospital in Region A with a workforce
of 669 (n=268) of the total workforce (n=4010) The core function of the hospital is
specialised such that some occupational categories are not available in the hospital as part
of the workforce and patients are referred out to other facilities for specialised treatment
Tara Moross Centre Hospital falls under the jurisdiction of the Johannesburg Metropolitan
Municipality
442 The Germiston Hospital
Germiston Hospital is a regional general hospital in Region B with a total permanent staff
establishment of 1070 (n= 429) of the total workforce (n=4010) The hospital falls under
the Ekurhuleni Metropolitan Municipality It does not have occupational therapists clinical
psychologists dieticians speech therapists and dentists in its permanent staff
443 The ODI District Hospital
The ODI District Hospital is in Region C and is in transition due to boundary changes It is
being transferred from the North West Province to the Gauteng Province The hospital is in
a semi-rural area with a staff component of 118 (n=474) of full-time employees (n=4010)
and falls under Tshwane Metropolitan Municipality It is a general district hospital
444 The George Mukhari Hospital
The George Mukhari Hospital is an academic hospital in Region C under Tshwane
Metropolitan Municipality The hospital trains doctors and employs 010 (n=3) White male
employees 26 (n=739) African males and7184 (n=2097) African females out of the
total female workforce (n=2919)
46
This phenomenon may be as a result of the hospital having the highest general assistants
workforce at 2065 (n=586) out of the workforce (n=2839) The George Mukhari Hospital
has the highest number of general assistants out of the four hospitals represented as 25
(n=719) in a total workforce of n=2836 African employees
45 RESEARCH INTERPRETATION
The interpretation of leave of absence is confined to salary level 1 to 12 full time employees
of the Gauteng Department of Health who took leave of absence from the workplace for the
calendar year in 2008 It excludes the contract employees periodic remuneration foreign
employees and permanent employees above salary range 13
The Basic Conditions of Employment Act 75 of 1997 Section 9 (3) (RSA 1997) prescribes
procedures in terms of progressive reduction of the maximum working hours to the goal of
a 40-hour working week and an eight-hour working day Finnemore and Van Rensburg
(2002462) state that the reduction of maximum working hours to 40 hours a week is done
through collective bargaining with due regard to job creation efficiency and health safety
and welfare of employees Du Toit and Van Der Waldt (1998232) use the formula to
aggregate lost working-man hours due to ill health and disability as aggregate lost hours in
the survey period divided by 40 hours in a week and x number of hours in a year A formula
to work out the absenteeism rate by Pierce (2009) is represented as A=BC A= Absenteeism
rate B= Total number of days lost due to absenteeism in a given period C= Total number of
working- man days available in the given period C=D x E D=Total number of employees
planned to work in the given period E=Number of available working days in the given
period
The approach of the research uses the principle of absence from the workplace when due to
work to identify the lost working hours (Pierce 2009 Davey amp Cummings 2009313) The
study applies a retrospective approach
The working-man lost days for the Province in the four hospitals is approached in terms of
lost working -man days simplified refers to the number of days meant to have been worked
but actually not worked due to illness or disability by the employees in a year divided by the
total number of employees of the public sector (PXVI) Barker (200779) argues that a
reduction in working hours increases the hourly cost of production and unit production
unless there is a commensurate increase in productivity This approach has a similar effect
on workplace absenteeism when the workload of those employees who are present
increases as they carry the double load to meet the demands of service delivery The cost of
absence to the Province is expressed as salary expenditure for each day of leave of absence
from the workplace (PSC 2002 xiii Pierce 2009)
47
The salary range is laid down according to Annexure in DPSA Circular 1 of 2008 The Gauteng
Government experienced a cost estimated at R29 million in 2000 and approximately R54
million in 2001 from absenteeism and loss of working time (Parbhoo20031)
The formula that is used in this research to calculate lost man work-hours is collective
working days of absence multiplied by 8 hours in a working day resulting in the total
working hours that are lost This formula can be represented as
Lost days x hours (8) in a working day = lost working hours
As stipulated by the Basic Conditions of Employment Act 75 of 1997 section 9 1(c) 3
TABLE 6 RACES IN RELATION TO ABSENTEEISM
RACE TOTAL DAYS OF ABSENTEEISM PERCENTAGE
Africans 14295 963
Whites 242 16
Coloureds 201 14
Indians 102 07
TOTALS 14840 100
(Source Compiled by the researcher 2012)
Table 6 represents absenteeism in the diverse races in the workplace The absenteeism rate
seems to be proportional to the number of employees The Employment Equity Act 55 of
1998 defines the term ldquoblackrdquo as a generic term which means Africans Coloureds and
Indians The Africans as a race group is represented by 963 (n=14295) of the total
working days lost (n=14840) The high figure of lost working-man days reflects the
demographics of the four hospitals The George Mukhari Hospital is in a rural setting that is
predominantly African populated and employs the highest number of Africans as
represented in table 3 Whites are presented by 16 and not represented in all
occupational categories and salary ranges that could explain the low figures and
percentages associated with working-man days lost Africans constitute the highest number
of employees as well as the highest percentage of working-man days lost Absenteeism
percentage is proportional to the employment figures for this race group The Indian race
group is represented by the lowest figure of employment and lowest percentage of leave of
absence which is proportional to the employment figure
48
TABLE 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM
OCCUPATIONAL
GROUPS
TARA GERMISTON ODI GEORGE
MUKHARI
TOTALS
DOCTORS 22 118 5 290 435
PROFESSIONAL NURSE 272 346 20 2459 3097
STAFF NURSE 128 247 13 1568 1956
NURSE-ASSISTANT 150 126 25 1145 1446
FINANCE 0 0 0 386 386
ADMINISTRATION 57 272 20 1923 2272
ADMIN SUPPORT 754 547 163 3784 5248
TOTAL 1383 1656 246 11555 14840
(Source Compiled by C S Ndhlovu 2012)
Table 7 reflects the working-man days lost by the different occupational groups The
doctorsrsquo workload in terms of the annual report for Gauteng Department of Health
(2008951) was 226 as against the target of 227 while the national target was 187
The bed occupancy rate target for the same time was 75 while the actual figure was
653 The annual report interpreted in conjunction with the data of leave of absence for
doctors reflects a negative impact in terms of service delivery and the cost factor to the
department
451 Occupational groups in relation to absenteeism
The multi-group invariance structural model presents different types of occupations and is
used to identify variance in the patterns in terms of occupational groups The model allows
different relationships between variables in different occupations The different
occupational groups are doctors professional nurses and sub-categories administration
staff and administration support staff (Pousette amp Hanse 2002230) According to Gaudine
and Gregory (2010599) absenteeism was a problem among health care workers in
comparison to other employees in other sectors The cornerstone of an efficient health care
service delivery is equity and efficiency which is threatened when employees are not at
work when expected to be (Andrews 199734-35 DPSA 1997)
49
According to the Charted Institute of Personnel Development (200811) the survey that was
conducted found that public sector employees are less likely to be disciplined or dismissed
for reasons of workplace absenteeism
Tables 5 and 6 and 7 reflect the different occupational groups and the level of absenteeism
in the four hospitals of the Gauteng Department of Health
4511 Doctors
Doctors are represented by 10 (n=397) of the total working population (n=4010) The
29 (n=435) indicates the number of working-man days lost in relation to the total
working- man days lost (n=14840) The percentage of working- man days lost in relation to
the total number of full time employees of the four hospitals is reflected as 435 divided by
n=4010 times the percentage which results in 108 (n=435) working-man days lost
multiplied by 8 hours that represent a working day The outcome is n=3480 working-man
hours The cost to the Province is calculated in terms of the salary expenditure as direct and
indirect salary payment for lost working-man hours estimated at 3480 hours at salary level
10 at R217 482 to salary level 12 at R 407745 as well as indirect costs such as replacement
of staff and overtime
The doctorsrsquo workload in terms of Gauteng Province 20089 annual report (2008951)
reflects the doctorrsquos workload as 226 as against the target of 227 while the national
target is reflected as 187 The bed occupancy rate target for the same time is 75 while
the actual target rate is 653 The annual report when interpreted in conjunction with the
data of leave of absence for doctors reflects a negative impact in terms of service delivery
and the cost factor to the Department when considering a loss of n=3480 man hours of
work
Chaudhury and Hammer (200311) found in their research that the doctors presented the
highest absenteeism rate Serneels et al (2008210) argue that absenteeism is rife in the
public sector where employees hold two jobs and is highest among doctors The doctor
absenteeism rate in the research does not stand out as high in comparison with the other
occupational groups The doctor absenteeism rate is 29 when compared to the total
workforce This occupational group is represented by 10 of the total population The
doctorsrsquo absenteeism rate does not seem to be outstandingly high in comparison with the
other occupational groups in relation to the total number of permanent doctors
50
4512 Professional nurses
The professional nursesrsquo absenteeism is reflected as 208 (n=3088) that indicates the
number of working-man days lost in relation to the total working-man days lost (n=14840)
The percentage of working-man days lost in relation to the total number of full time
employees (n=4010) in the four hospitals is reflected as 77 The cost to the Province
translates into direct and indirect salary expenditure which is spread from salary level 4 to
12 at R64 410 to R407 745 in 2008 for the total duration of lost working days
Du Toit and Van Der Waldt (1998232) pointed out a crisis in four other public hospitals in
the Gauteng Province that was caused by budget cuts and shortage of doctors and nurses in
2008 The vacancy rate of 697 in the professional nurse category and the absence rate of
208 in 2008 in the four hospitals seem to point to a lack of adequate human resources for
effective health care delivery The extent of working-man hours lost in the findings of the
research suggest a high rate of absenteeism and not a good reflection of happiness as
suggested in the annual report Professional nurses are second to the administration
support in absenteeism at 208 at a total of (n=785) nurses in the four hospitals with
absenteeism of n=3088 working-man days lost or n=20704 working-man hours lost This
category of employees is classified as skilled to highly skilled at salary range of 4 to 12The
total vacancy rate was at 697 as against the national target at 15 in 2008 with
absenteeism of 208 Madibana (201022) found in the research about absenteeism
among nurses that the high rate of absence had a negative impact in the quality of health
care rendered by nurses
4513 Staff nurses
Staff nurses are reflected in tables 4 and 5 as representing 12 (n=482) of the total working
population (n=4010) The 132 (n=1956) indicates the number of working-man days lost
in relation to the total working-man days lost (n=14840) times the percentage
The percentage of working-man days lost in relation to the total number of full time
employees in the four hospitals is reflected as 488 The cost to the Department is
expressed as direct and indirect salary expenditure for n=15648 working-man hours lost
The impact of leave of absence to health care services and cost to the Department is the
same as the professional nurses as staff nurses are a sub-category of the nursing profession
4514 Nursing assistants
Nursing assistants are reflected in tables 4 and 5 as represented by 107 (n=429) of the
total working population (n=4010) and 97 (n=1446) represent working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The
percentage of working-man days lost is reflected as 36 (n=1446) in relation to the total
number of employees in the four hospitals (n=4010)
51
The cost of leave of absence to the Department is expressed as the salary expenditure at
salary levels 3 to 6 Salary level 3 is at R54 876 salary level 4 is at R64 410 salary level 5 at
R76 194 and salary level 6 is at R94 000 for n=11568 working-man hours lost and staff
replacement and overtime
4515 Finance officers
Finance officers are reflected in tables 5 and 7 as represented by 21 (n=83) of the total
working population (n=4010) and 26 (n=386) indicates the working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The cost to the
Department is reflected as salary expenditure from salary level 2 at R47 787 to salary level
10 at R217 482 for R2 728 working hours lost The institutions reflected a small number of
this occupational category as permanent employees place them in the category of scarce
skills
4516 Administration staff
The administration staff is represented in tables 2 and 4 and 5 by 116 (n=466) in the total
working population (n=4010) and 153 (n=2272) indicates the working-man hours lost in
relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 567 represent the working-man days lost in relation to the total number of
full time employees in the four hospitals (n=4010) The cost of leave of absence to the
department is reflected as salary expenditure at salary level 4 to 12 Salary 4 at R64 410 to
salary level 12 at R407 745 for 18176 working hours lost
4517 Administration support
The administration support is reflected in tables 2 and 4 and 5 as represented by 273
(n=1095) of the total working population 354 (n=5248) indicates the working-man days
lost in relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 1309 (n=5248) indicates the working-man days lost in relation to the total
number of employees in the four hospitals (n=4010) The total cost to the Department is
reflected as salary expenditure at salary level 2 to 3 at a cost of R47 787 to R54 879 for
41984 working -man hours lost
The highest percentage of absenteeism in the different categories of employees in the four
hospitals is identified in the administration support category It is this category that falls into
the salary range of 2 and 3 which is classified in the Gauteng Province 20089 annual report
(20089325) as lower skilled employees This category represents the highest single
category of employees for the Department at n=1095
52
The impact to the core service delivery employees that require support from administration
staff would seem to be negative as the absence of employees from the workplace would
hamper the smooth workflow Barker (2007214-224) acknowledges the decline in the flow-
through rate in the school education higher grades namely Grade 11 and Grade 12 and
ventures to give possible reasons for this phenomenon The Gauteng Department of Health
as a possible employer has attracted a high percentage of the labourer category as
identified in table 3 totalling n=1095 which is 273 of the total workforce Pousette and
Hanse (2002230-231) suggest that the employeersquos authority to make decisions in his or her
job and the breadth of use of skills used by the employees at work become different aspects
of control with human service at work This approach suggests that reduced job autonomy is
associated with higher sickness absence The administrative support employees are involved
in mechanical or manual labour that predisposes them to musculo-skeletal problems The
work environment could have a negative impact to the high absenteeism rate in this group
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM AS REPRESENTED BY
THE HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 43 reflects the absenteeism rate of the different occupational groups as represented
by the hospitals The George Mukhari Hospital contributes 7079 to the total workforce
and contributes about 779 to absenteeism The absenteeism rate does seem to be low at
7 when considered in the light of the contribution The question that maybe be raised is
whether the relative low absenteeism is indicative of high morale of a happy workforce
53
ODI 17
TARA 93
GERMISTON 111
GEORGE MUKHARI 779
Germiston Hospital contributes 106 to the total workforce and the absenteeism is
reflected as 111 which seems to be above its contribution to the workforce by 1 The
professional nurse and the administration category present with the highest rate of
absenteeism in this hospital The Tara Moross Centre Hospital contributes 67 of the total
workforce and the absenteeism rate is at 93 which is 26 higher The administration
support and professional nurses present with the highest level of absenteeism in this
hospital The ODI Hospital contributes 6 to the total workforce and the absenteeism rate
which seems to be low is reflected as 17 This hospital has no access to the Persal system
and is dependent to a neighbouring hospital It is highly probable that the information is not
accurate
Allen (1984 331) found that union members might be absent more frequently from the
workplace than non-members because they face smaller penalties for absenteeism The
Charted Institute of Personnel and Development (CIPD) (200811) claim that the 2006
survey of absence management portrays the public sector employees as less likely to be
dismissed for reasons of workplace absenteeism
TABLE 8 SALARY RANGE IN RELATION TO ABSENTEEISM (SALARY RANGE 1-12)
SALARY RANGE DAYS OF ABSENCE PERCENTAGE
1-2 178 12
3-4 5235 353
5-6 2044 138
7-8 5139 346
9-10 1878 126
11-12 366 25
TOTAL 14840 100
(Source Compile by the researcher C S Ndhlovu 2012)
Table 8 reflects the salary range with the lowest working days lost as salary level 1 to 2 This
is proportional to the number of employees The highest absenteeism rate has been noted
in the salary range at level 3 to 4 while salary ranges at level 11 to 12 reflected a low rate of
absenteeism The latter salary range is at middle management level and the responsibility
the employees carry may be responsible for the low absenteeism rate Rogers and Hertin
(1993219) noted that the level of education seem to have influenced the use of sick leave
where the lower level category employees were found to have higher level of absenteeism
than higher educated employees
54
TABLE 9 AGE IN RELATION TO ABSENTEEISM
AGE IN YEARS DAYS OF ABSENCE PERCENTAGE
20 to 24 16 010
25 to 29 405 272
30 to 34 733 493
35 to 39 1582 1066
40 to 44 2676 1803
45 to 49 3318 2235
50 to 54 3046 2052
55 to 59 2235 1506
60 to 64 829 558
TOTAL 14840 9999(100)
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 9 reflects age in relation to absenteeism in the four hospitals The age group at 20 to
24 years reflects the lowest figure in working-man days lost at 010 (n=16 days)
Reday-Mulvey (200579) observed that employees over 45 years take marginally fewer short
sick leave days per year than those under 45years
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 to 55 years
as middle -age and shows this group as presenting with a high incapacity leave usage In the
research the age group 45 to 49 years presented with 2235 (n=3318) working-man days
lost and is the highest figure of absenteeism in all age groups The age group at 20 to 24
years is reflected as the lowest absenteeism rate in working-man days at 010 and this
could be related to the number of employees in this age group
According to Reday-Mulvey (20057988) and the Canadian Nurses Association (20065)
employees that are over 45 years take marginally fewer short sick leave periods but take
slightly longer sick days per year than those under 45 years and reflect higher absenteeism
in the age group above 50 years
55
Weeks (200454) found that employees at the age group represented by 51 to 60 years
show less absence which may be because of ill health retirement benefits The age 31 to 40
and 41 to 50 years show higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full time jobs and suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee In the study the age group 55 to 59 years show a decline in absenteeism in
comparison to 50 to 54 while age 60 to 64 shows the lowest rate
The aging employee has been found to expose the institutions to high levels of absenteeism
through a higher probability of becoming incapacitated for longer periods (Ferguson et al
200138) and the current research have pointed differently Rogers and Hertin (1993219)
found a significant correlation between the use of sick leave and age suggesting employees
with advanced age used more sick leave in comparison with the younger employees The
current socio-economic culture encourages retirement from active employment at the age
of 65 years and the research adopted that approach as a cut off point for employment
(Nichols amp Evangelisti 2001285)
TABLE 10 GENDER IN RELATION TO ABSENTEEISM
GENDER TOTAL
NUMBER
DAYS OF
ABSENCE
PERCENTAGE
Males 1006 2490 168
Females 3004 12350 832
Total 4010 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 10 reflects gender in relation to absenteeism The duration of working-man days lost
is higher in female employees at 8325 (n=12350) and is represented by 749 (n=3004) in
relation to the total number of employees in the four hospitals (n=4010) as represented in
table 3 The male employees employed by the Department are reflected as absent from
work by 1680 (n=1006) and represented as 251 in relation to the total number of
employees in the four hospitals (n=4010)
The Public Service Commission (PSC 200222) found that more males took sick leave than
females except for the age group of 16 to 19 years QUALSA (200923) noted that females
had the highest number of incapacity applications in comparison to their male counterparts
Qualsa attributed this pattern to the fact that female employees constitute a higher
percentage of the employee population within the Gauteng Department of Health
56
Roger and Hertin (1993222) noted that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees could have an
impact on the high number of absenteeism reflected by the women
452 Race in relation to absenteeism
The working population of the four hospitals is represented by four race groups such as
Africans Whites Coloureds and Indians
4521 Africans
Africans represent 973 (n=3902) of the total working population (n=4010) and 963
(n=14295) indicates the working-man days lost in relation to the total working-man days
lost (n= 14840) times the percentage 3565 (n= 14295) reflects the working-man days
lost in relation to the total number of employees in the four hospitals (n=4010) The 14295
working-man days lost are multiplied by 8 hours that represent a day and translates into
963 (n=114360) working-man hours lost The cost to the Department is translated as
salary expenditure for n=114360 workingndashman hours lost and the indirect cost of staff
replacement and overtime Africans constitute the highest number of employees as well as
the highest percentage of working-man hours lost Absenteeism percentage is proportional
to the employment figures for this race group
4522 Whites
Whites are represented as 13 (n=51) of the total workforce (n=4010) and 16 (n=242)
represent the working-man days lost in relation to the total working-man days lost
(n=14840) times percentage 61 (n=242) represent working- man days lost in relation to
the total number of employees in the four hospitals The 232 working-man hours lost are
multiplied by 8 hours that represent a working- man day that translates into 16 (n=1856)
working-man hours lost The cost to the Department is represented as salary expenditure of
(n=1856) working-man hours lost that is paid to the unproductive employees This race
group of employees is not represented in all occupational categories and salary ranges
which may explain the low figures and percentages associated with working-man days lost
(n=242) The demographics of the different hospitals may contribute to the low
representation of this group in the total workforce
4523 Coloureds
Coloureds are reflected as 11 (n=43) of the total workforce (n=4010) 14 (n=201)
represent working- man days lost in relation to the total working- man days lost (n=14840)
5 (n=201) indicates working- man days lost in relation to the total number of employees in
the four hospitals (n=4010)
57
The cost to the department is represented as salary expenditure for n=1608 working-man
hours that are lost This race group is represented in three of the four hospitals and not in
all categories and salary ranges which may explain the low representation and
absenteeism
4524 Indians
Indians represent 03 (n=14) of the total workforce (n=4010) in table 6 07 (n=102)
represent working- man days lost in relation to the total working- man days lost (n= 14840)
times percentage 25 (n=102) indicates working- man days lost in relation to the total
number of employees in the four hospitals (n=4010) The 102 working- man days lost are
multiplied by 8 hours that represent a working-man day and translates into 07 (n=816)
working- man hours lost The cost to the Department is expressed as salary expenditure
paid to the unproductive employees for duration of (n=816) working-man hours lost This
race group is not represented in two of the four hospitals in some occupational categories
and salary ranges The Indian race group is represented by the lowest figure of employment
and lowest percentage of leave of absence which is proportional to the employment figure
FIGURE 44 RACES IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 44 reflects the different races in relation to absenteeism The Africans as a race
group is represented by 963 of working-man days lost (n=14840) The high figure of lost
working-man days reflects the demographics of the four hospitals
58
14840 DAYS
(100)
Africans 963
whites 16
coloureds 14
Indians 07
The George Mukhari Hospital is in a semi-rural setting that is predominantly African
populated and employs the highest number of Africans as represented in table 1 (n=2836)
Whites are presented by 16 absenteeism rate and not represented in all occupational
categories and salary ranges which could explain the low figures and percentages associated
with lost working days The absenteeism rate for Indians is represented as 07 and
Coloureds as 14
The Africans as a race group constitute the highest number of employees as well as the
highest percentage of working days lost Absenteeism percentage is proportional to the
employment figures for this race group The Indian race group is represented by the lowest
figure of employment and lowest percentage of leave of absence which is proportional to
the employment figure The South African Survey Millennium (1999-200028) reflected the
African males in 1998 as 354 and females as 348 the Coloured males as 39 and
females as 46 Indian males as 39 and females as 15 and White males as 83 and
females as 94 There has been no significant change in the race group representation in
the working population of the four hospitals
453 Tenure in relation to absenteeism
Tenure in years is grouped in units of ten (10) Tenure in 1 to 10 years 11 to 20 years 21 to
30 years 31 to 40 years of all occupational groups are represented in figure 27 as the total
leave of absence utilised by the full-time employees of different occupational groups in
terms of tenure which translates into n=14840 working-man days lost The lowest hours lost
is at tenure 31 to 40 years of service which is reflected as 59 (n=878) working- man days
lost The highest working-man days lost is at tenure of service of 11 to 20 years reflected as
443 (n= 6577) working- man days lost Tenure of service of 1 to 10 years reflects 30
(n=4451) working-man days lost and tenure of years at 21 to 30 years reflects 198 (n=
2934) working- man days lost
Rogers and Hertin (1993222) express tenure as work experience in years that is viewed as a
predictor of employee productivity where seniority has been found to be inversely related to
absenteeism in terms of frequency and total number of work days lost The Canadian Nurses
Association (20065) suggests that job tenure increases with age as illustrated in their
research where nurses were found to have both job tenure of 20 years or more and are over
45 years of age In the research the tenure of 31 years to 40 years presented with the lowest
absenteeism rate in agreement with Rogers and Hertin (1993222)
59
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 45 reflects the total leave of absence from tenure of 1 year to 40 years The PERSAL
system reflected 40 years as representing more or less 64 years of age and 65 years is the
cut off point for full time employees in the system The lowest working- man days lost is at
tenure of 31 to 40 years of service which is reflected as 590 and represents the older
employee in general The highest working- man days lost is reflected at tenure of 11 to 20
which is presented as 4430 representing the younger employee This is an area of concern
as table 5 reflects professional nursesrsquo absenteeism rate at 208 and administration
support staff at 356 and is possible that the absenteeism rate of the two occupational
categories may be a bigger contributor to the high absenteeism rate reflected in the tenure
of 11 years to 20 years
454 Salary range in relation to absenteeism
The salary range is interpreted in the study as a salary broad band that is represented in
table 9 and ranges from level 1 to 12 Rogers and Hertin (1993 219) claim that the level of
education does seem to have a bearing on the salary range use of sick leave where the
lower level category employees were found to have higher levels of absenteeism than the
higher educated employee The Human Resource Development Strategy (Gauteng Province
200815214) claims that the chances of entering into a higher income bracket in South
Africa rises noticeably after people have twelve years of education The ages 20 to 24 years
are greatly affected by this assumption
60
0
20
40
60
Tenure 1-10Tenure 11-20
Tenure 21-30Tenure 31-40
30 4430
1980
590
Tenure
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 46 above reflects the salary range from 1 to 12 in relation to working- man days lost
as salary range 1 to 2 as n=178 working-man days lost which converts to 12 The highest
absenteeism rate has been noted in the salary range at level 3 to 4 at 3530 (n=5235)
working-man days lost while salary ranges at level 7 to 8 is reflected as the second highest
level of absenteeism at 346 (n=5139) lost working-man days
Salary range at 5 to 6 is reflected as the third highest in absenteeism at 138 (n=2044) lost
working-man days Salary range 9 to 10 is regarded as the entry point to middle
management and is reflected as the fourth highest at 126 (n=1878) working-man days
lost Salary range at 11 to 12 is regarded as middle management entrusted with high levels
of authority and accountability This group is reflected as losing 25 (n=366) working- man
days lost which is considered to be a reasonable low level of absenteeism
455 Age of full time employees in relation to absenteeism
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 years to 55
years as middle-age and shows this group as presenting with a high incapacity leave usage
In the research the age group of 45 years to 49 years is represented with 2235 (n=3318)
working- man days lost and is the highest figure of absenteeism in all age groups
61
178
5235
2044
5139
1878
366
0
1000
2000
3000
4000
5000
6000
Salary range1-2
Salary range3-4
Salary range5-6
Salary range7-8
Salary range9-10
Salary range11-12
DAYS OF ABSENTEEISM
Reday-Mulvey (20057988) and Canadian Nurses Association (20065) observed that
employees over 45 years take marginally fewer short sick leave periods but take slightly
longer sick days per year than those under 45 years and reflect higher absenteeism in the
age group above 50 years
Weeks (200454) claims that the age group at 51years to 60 years show less absence may be
because of ill health retirement benefits The age group of 31 years to 40 years and 41years
to 50 years show a higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full-time jobs He suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee The aging employee has been found to expose the institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods
(Ferguson et al 200138)
Rogers and Hertin (1993219) claim that there is a significant correlation between the use of
sick leave and age suggesting employees with advanced age comparatively used more sick
leave in comparison with the younger employees The current socio-economic culture
encourages retirement from active employment at the age of 65years and the research
adopted that approach as a cut off point for employment (Nichols amp Evangelisti 2001285)
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 47 reflects the number of working-man days lost by full-time employees through
absenteeism related to a specific age
62
16
405
733
1582
2676
3318
3046
2235
829
0
500
1000
1500
2000
2500
3000
3500
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Days of absence
Days of absence
Age groups are organised in units of 5 to be consistent with the Personnel and Salary
Administration System (PERSAL) The age group at 20 years to 24 years reflects the lowest
percentage of absenteeism at 010 (n=16) working-man days lost and the age group of 45
years to 49 years reflect the highest days of absenteeism at 2235 (n=3318)
456 Gender in relation to absenteeism
The females employed in the Department of the four hospitals are represented as 749
(n=3004) in relation to the total number of employees in the four hospitals (n=4010) and
lost 8320 (n=12350) working-man days This absenteeism rate is considered high
considering that not every female employee may have used sick leave The male employees
employed in the Department are represented by 25 (n=1006) of the total workforce
(n=4010) and lost 168 (n=2490) working-man days The findings suggest that males
utilised fewer days of sick leave considering the fact that not every male employee may
have utilised sick leave for the duration of the study
The Public Service Commission (PSC 200222) claims that more males took sick leave than
females except for the age group of 16 years to 19 years QUALSA (200923) noted that
females had the highest number of incapacity applications compared to their male
counterparts Qualsa attributed this pattern to the fact that female employees constitute a
higher percentage of the employee population within the Gauteng Department of Health
Rogers and Hertin (1993222) argue that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees may have an
impact on the high rate of absenteeism
63
FIGURE 48 GENDER IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 48 reflects gender in relation to absenteeism The females employed by the
department in the four hospitals are reflected as absent from work at a rate of 8320
(n=12350) working-man days and represented by 749 (n=3004) in relation to the total
number of employees (n=4010) in the four hospitals The male employees employed by the
Department are reflected as absent from work at 1680 (n=2490) and represented as
251 (n=1004) in relation to the total number of employees in the four hospitals
(n=4010)
457 Week days in relation to occupational groups
Table 11 reflects the trends in terms of days of the week that show high utilisation by the
different occupational groups Mondays Fridays and Thursdays reflect a high utilisation rate
by the employees suggesting a pattern of high absenteeism rate over weekends
Professional nurses and sub-categories and the administration support group reflected the
highest absenteeism over the weekends
64
1680
8320
000
1000
2000
3000
4000
5000
6000
7000
8000
9000
Males Females
GENDER ABSENCE
TABLE 11 WEEK DAYS IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
OCCUPATIONAL
CATEGORY
MONDAY TUESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Doctors 18 8 13 17 0 0
Professional
Nurse
135 86 94 137 0 0
Staff Nurse 52 38 56 65 2 0
Nursing
Assistant
62 27 34 45 2 0
Administration
Staff
64 38 58 73 1 0
Administration
support
252 147 98 126 26 15
Finance officer 17 4 8 16 0 0
TOTAL 600(4) 348(23) 361(24) 479(32) 31(02) 15(010)
(Source Compiled by C S Ndhlovu 2012)
Table 11 reflects the pattern of how the different occupational groups utilised sick leave on
the different days of the week It illustrates the days that sick leave started on each day of
the week The largest number of incidences of sick leave commence on Monday the first
working day of the week as reflected by 4 (n=600) of the days of the weekend Fridays are
the second highest days of absenteeism represented by 32 (n=479) Tuesdays and
Thursday are almost the same in utilisation as reflected by 23 and 24 respectively
Professional nursesrsquo absenteeism was pronounced on Mondays as 2250 (n=135) and
Fridays as 2861 (n=137) a trend that shows possible long weekend absenteeism
The administration support staff has been reflected as mostly absent on Mondays 42
(n=252 days) and Fridays 2631 (n=126 days) The administration support reflected the
highest days of absenteeism on Saturday (n=26) and Sunday (n=15) The Canadian Nurses
Association (CNA) (2006) focused on seasonal pattern of absenteeism in the different
categories in the different hospitals The PSC (2002) report identified a trend by provincial
employees of using sick leave to extend their weekends The research considered working-
man days lost in terms of days of absence as in accordance with evidence of a medical
certificate Administration support is the only group that seem to have utilised Saturdays
for sick leave 8387 (n=26) and Sundays 100 (n=15) days
65
TABLE 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALS
INSTITUTIONAL
CONTRIBUTION
TARA MOROSS
CENTRE
GERMISTON ODI GEORGE
MUKHARI
TOTAL
Contribution to
Sample
668 1070 1182 7080 100
Contribution to
Absenteeism
842 1177 165 7816 100
(Compiled by C S Ndhlovu 2012)
Table 12 reflects the contribution of each hospital to absenteeism Tara Moross Centre
Hospital contributed 67 to the sample and the absence rate is higher than the
contribution at 84 The Germiston Hospital contributed 107 to the sample and the
absenteeism rate is higher at 117 The George Mukhari Hospital contributed 708 to the
sample and absenteeism rate is at 782 and ODI Hospital contributed 118 and
absenteeism rate is at 17 The latter hospital has no computers at The reflection of the
status of absenteeism is likely to be inaccurate The George Mukhari Hospital has the
highest contribution to the sample yet leave of absenteeism is tolerable It raises questions
as to what should be the contributory factor to the leave of absence status in this hospital
46 CONCLUSION
Chapter 4 presented the analysed data in terms of the characteristics as determined in the
stratified random sampling The characteristics and their association with absenteeism have
been presented such as occupational categories age gender tenure of service and race
The research identified which days of the week were utilised for sick leave absence The
contribution of each hospital to absenteeism was identified and a brief overview of each
hospital was presented
Chapter 5 presents the findings conclusion and recommendation of the research
66
CHAPTER 5
FINDINGS CONCLUSIONS AND RECOMMENDATIONS
51 INTRODUCTION
Chapter 1 provides a general introduction to the research It included the background and
motivation for the research that provides the context the problem statement and the
significance of the research The key concepts are defined The research design the method
of data collection the sampling method data analysis and interpretation and limitations to
the research are explained in this chapter
Chapter 2 considers the theoretical foundations concepts characteristics theories
approaches and classifications of workplace absenteeism The discussions on the conceptual
framework of absenteeism predictors of absenteeism and various models of absenteeism
are presented Measures to control workplace absenteeism and the impact of absenteeism
in an institution and management intervention strategies in workplace absenteeism were
discussed
Chapter 3 describes the research design and the different aspects of the research methods
that were applied to the research The chapter explains the various data collection
techniques that are used unit of analysis units of observations construct validity and
ethical considerations
Chapter 4 provides the organisational structure of the Gauteng Department of Health
comparisons of hospital employees different race groups of the four hospitals gender
comparisons in different hospitals and comparisons of the different occupational groups It
provides a short description of the target hospitals The research interpretation is discussed
in terms of the different occupational groups and absenteeism different races and
absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism The trends of week days of
absenteeism in the four hospitals and contributions to absenteeism by the four hospitals are
presented
Chapter 5 explains a synthesis of the study and evaluation of workplace absenteeism The
findings of the research and recommendations are discussed
52 FINDINGS
The findings of the research reflect doctors as represented by 108 in the total workforce
(n=4010) have an incidence of 29 (n=435) of the total work-man days lost (n= 14840) by
the employees in the four hospitals translating to a total of n=3480 working hours lost
67
The working-time lost is considered against the doctorsrsquo workload of 226 in contrast to the
target of as 227 while the national target was 187 The bed occupancy rate target was 75
while the actual figure was 653 The annual report when it is interpreted in conjunction
with the sick leave absence of doctors at 29 shows no negative impact on the workload in
terms of service delivery The negative impact is mainly on the cost factor to the state as the
doctorrsquos salary level is from salary level 10 at a cost of R217482 to salary level 12 at
R407745 (Gauteng Province annual report 2008951) Serneels et al (2008210) claim that
absenteeism occurs primarily in the public sector associated with people who hold two jobs
and that is highest and more frequent amongst doctors The findings of the research of
absence of 29 with a contribution of 2 to the sample are in disagreement with the
Serneels et al findings
Professional nurses represent 196 (n=785) of the total workforce (n=4010) The
workplace absenteeism is represented as 77 (n=3088) of the total workforce (n=4010)
translating into 21 of working-man days that are lost (n=14840) The absenteeism rate
appears to be very high given the fact that nurses by virtue of their numbers are the
backbone of health care service delivery (DPSA 2009) The Gauteng Province annual report
of 2008951 reflects the total vacancy rate of nurses at 697 as against the national target
of 15 The absenteeism rate of 77 is very high when compared with the total vacancy
rate and 19 contribution to the sample Staff nurses are a sub-category of the nursing
profession and the impact of their absence to service delivery is the same as the
professional nurses The findings of the study reflect staff nurses representing 12 (n=482)
of the total working force (n=4010) The absenteeism from staff nurses is reflected as 13
(n=1956) of the total working-man days lost (n=14840) The absenteeism rate does appear
to be high when considering the contribution of 13 to the absence rate by a sample of 12
to the total working-man days lost Nursing assistants are a sub-category of the nursing
profession that is reflected as 107 (n=429) of the total number of employees (n=4010)
and represent 97 (n=1445) of the total working-man days lost (n=14840) This absence
rate is considered as high when compared with the total number of employees
The nursing occupational group considered collectively contributed to absenteeism at the
workplace at 997 which is extremely high Davey and Cummings (2009312-313) claim
that frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased
staff morale and high cost to health care The high absenteeism rate has a negative impact
on health care service delivery
The findings of the research reflect administration staff as 116 (n=466) of the total
number of employees (n=4010) represented by 154 (n=2286 days) of the total working-
man days lost (n=14840) Administration support is at salary level 1 to 2 with exceptional
instances of salary level 3 to 4
68
Administration support staff is reflected as 273 (n=1095) of the total workforce (n=
4010) represented by 356 (n=5289 days) of the total working-man days lost (n=14840)
translating to n=42312 lost working-man hours
The administration staff viewed collectively contributed 51 to absenteeism which is very
high with the support staff reflected as 356 Rogers and Hertin (1993219) claim that the
level of education seem to have influenced the use of sick leave where the lower skilled
category of employees were found to have higher levels of absenteeism than higher
educated or skilled employees The findings of the research reflect the administration
support staff to be in line with the Roger and Hertin findings
The Gauteng Department of Health has a limited number of finance officers causing them to
be a scarce skill occupational group The finance officers represent 2 (n=83) of the total
workforce (n=4010) The working-man days lost are reflected as 23 (n=341) of the total
working-man days lost (n=14840) The total absence at 23 is higher than the actual
contribution to the sample at 2
The age group of 45 years to 49 years reflects the highest absenteeism rate at 224
(n=3318) the age group at 50 years to 54 years is reflected as 205 absenteeism The age
group 40 years to 44 years reflected as 18 absent from the workplace The age group of 55
years to 59 years is reflected as 15 absenteeism Employees of advanced age used more
sick leave in comparison with the younger employees This phenomenon could be attributed
to the ageing process of the body and the onset of incapacity Absenteeism has been found
to be higher in employees who are over 50 years of age and the phenomenon is attributed
to age and changing abilities that increase when work is performed full- time The findings
of the research reflect the age group over 50 years at 205 and reflect the highest
absenteeism rate at age 45 years to 49 years as 224 (McGoldrick amp Arrowsmith 200184
MINTRAC 20093 Nichols amp Evangelisti 2001285 Reday-Mulvey 200579-194) According to
Ferguson et al (200138) the aging employee presents with high levels of absenteeism
through higher probabilities of becoming disabled for longer periods The findings of the
study reflect absenteeism of the age group of 55 years to 59 years at 15 which is the
lowest in the age groups The Canadian Nurses Association in (20065) noted a reduction in
workplace absenteeism rate among nurses who are less than 45 years of age and an
increase in the absenteeism rate among nurses above 55 years of age According to Bangali
(20043-4) the falling rate of the older employee age group could be influenced by the
practice of early retirement or voluntary severance which was used in the 1990s as a
method of restructuring in institutions Rogers and Hertin (1993219) claim employees with
advanced age used more sick leave in comparison with the younger employees
69
The group at tenure 11 to 20 years presented with the highest level of absenteeism at
443 The employee at tenure of 21 to 30 years presented with 198 of absenteeism rate
while the employees at 1 to 10 years presented with the rate of 30 The findings of the
research reflected tenure of 31 to 40 years to have presented with the lowest absenteeism
rate at 59 (n=878 days) This low absenteeism rate could be ascribed to the fact that
numbers of employees are reduced in this group or could also be commitment to their jobs
or could have higher ambition levels to aspire to higher posts
Van Der Westhuizen (2006136) and Rogers and Hertin (1993222) express tenure as work
experience that may be viewed as a predictor of employee productivity where seniority has
been found to be inversely related to absenteeism in terms of frequency and total number
of working-man days lost The public service employees enjoy security of tenure which may
contribute to the unacceptably high levels of absenteeism (Andrews 1997221ndash222
MINTRAC 20093)
The findings of the research reflect females as 75 of the total workforce (n=4010)
represented by 832 (n=12350) of the total working-man days lost (n=14840) The males
represent 25 of the total workforce (n=4010) and are reflected as absent at 168
(n=2490) of the total days of absence (n=14840)The absenteeism rate is very high for
females in this research Rogers and Hertin (199322) and Van Der Westhuizen (2006136)
suggest that women are absent from workplace more than men are Landstad et al (20011)
found that women cleaners who received preventive personnel support depicted a
reduction in absenteeism rate Hoxsey (2010562) claims that although women presented
with a high score of job satisfaction than men they maintained higher levels of
absenteeism MINTRAC (20094ndash8) found that gender moderates the age turnover
relationship Women are more likely to remain in their jobs the older they get than men do
The findings of the research reflect Africans as represented by 26 of the working
population and utilised 963 of the total working-man days lost due to sick leave It is
possible that the overall number of Africans influenced what seems to be a high level of
absenteeism at 963 Whites represented 03 of the working population and
absenteeism is reflected as 16 of the total working-man days lost Coloureds are
represented by 03 of the working-man population and absenteeism was recorded as 14
of the working-man days lost The Indians are represented by 01 of the total working
population and are reflected as 07 of the working-man days lost
The findings of the research reflect the salary range at level 11 to 12 utilised 25 working-
man days for sick leave salary level 7 to 8 which is the supervisory level utilised 346
working-man days lost salary level 3 to 4 which is the entry level of skilled workers utilised
353 working-man days lost The findings suggest management used fewer days of sick
leave in comparison to the supervisory level and entry skilled worker level
70
This can be ascribed to the fact that they are ultimately responsible for the institutionrsquos
effectiveness and productivity
The George Mukhari Hospital contributed 708 to the sample and reflected 771
absenteeism which is relatively low in comparison to the size of the contribution It could be
that processes and procedures of controlling leave of absence are in place The Tara Moross
Centre Hospital contributed 67 to the sample and reflected 93 absenteeism rate that is
high by 26
Professional nurses reflected a trend of high absence over the weekend including
Thursdays This could be a sign of burn out and extending the period of rest from possible
high workloads resulting from high vacancy rates (Gauteng Province annual report 20089)
Nyathi (200059) and the PSC (2002) found that employees are absent from work because
they want to prolong the weekend
53 CONCLUSIONS
The absenteeism rate is very high for females in this research The aging employee presents
with high levels of absenteeism through higher probabilities of becoming disabled for longer
periods The use it or lose it approach of the current system rewards the abuse of sick leave
as it is viewed as not being beneficial by the employees to act responsibly towards the use
of sick leave
The vacancy rate of 697 in the professional nurse category and the absence rate of 208
in 2008 in the four hospitals can only suggest inadequate levels of human resource for
effective efficient quality health care services at a high cost to the Province The nurses
may not be aware of the actual absenteeism or they under-estimate it The combination of
high registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery
Professional nurses and administration support staff have absented themselves from the
workplace predominantly on Mondays and Fridays It could be for various reasons ranging
from feelings of burn out to extending the weekend
The percentage of working-man days lost in relation to the total number of full-time
employees in the four hospitals is reflected as 488 which is very high as there is no
deterrent not to abuse sick leave in the public sector The findings of the research found a
significant correlation between the occupation and use of sick leave age and the use of sick
leave gender and use of sick leave and tenure and use of sick leave
71
The biggest hospital George Mukhari presented the lowest rate of absenteeism for its size
and complexity which reflects an empowered management The Tara Moross Centre
Hospital is the smallest hospital highly specialised and presented with high rate of
absenteeism for its contribution which may be a reflection on the skills of its management
or the type of health care service that is offered by the institution
The international norm of absenteeism is 3 The research established the absence rate at
488 The Gauteng Department of Health is held at ransom by the five trade unions it has
signed agreements with and that makes it difficult for managers to manage absenteeism
The practise of Gauteng Department of Health Head office to remove managers from
institutions when there is a labour unrest exacerbates the problem of managing
institutions
The findings of the research could not establish a representative reflection of race and
absenteeism as Indians Coloured and Whites were not represented in some institutionsrsquo
demographics
54 RECOMMENDATIONS
The White Paper on Transforming Public Service holds management responsible for
delivering specific levels of services and for obtaining value for money in wider utilising of
resources This strategy is to be translated into action The Gauteng Department of Health
should probably benefit by adopting the total absence management philosophy by
cultivating a culture that is not tolerant of high levels of absenteeism through building it in
as a key performance area of the performance of all managers and all employees The
current performance dimension system should lay explicit emphasis on this aspect
The re-engagement of knowledge based and professional retirees at reasonable
remuneration levels to reward their expertise may assist in reviving good work ethics by
mentoring the new and generally young recruits The retired professionals are currently
resisting the call for re-employment on a contract basis at entry level
The Gauteng Department of Health can encourage flexitime in terms of 58 or 68 to allow
the mature employee to remain within the system with the view to share their knowledge
and skills with the young employees who may be highly qualified but lack experience This
approach may deal with the need for adequate human resources for health care delivery at
reduced cost as two employees on flexitime basis can occupy one full-time employeersquos post
Managers should use the return-to-work counselling strategy to solicit feedback from the
employee about the actual absenteeism The counselling should be on a one-to-one basis
This approach may raise self-awareness to the employees in terms of the impact of the
employeersquos absence frothed workplace
72
Currently this intervention strategy is not adequately utilised for fear of confrontation with
labour representatives
Managers should have attendance policies in place effectively communicate policies to
employees adhere to policies and procedures and use absence control strategies
consistently This approach will minimise the feeling of injustice by employees Currently the
human resource unit is challenged by a high staff turnover due to promotions from the
human resource area a situation that creates a vacuum and lack of continuity weakening
the process of empowering line managers by human resource practitioners This high staff
turnover may be controlled through upgrading of the human resource salaries as the
salaries fall out of the occupation service dispensation (OSD)
Managers in the public service are expected to be responsible and accountable for their
portfolios including management of leave of absence and should not shift it to the human
resource unit as is currently the practice It should be possible to charge a manager as an
accomplice for failing to manage the absence of employees where there is no evidence of
corrective remedial action where it has been warranted The researcher takes cognisance of
the fact that the public service is highly unionised and this approach may trigger industrial
action
The employer needs to revive on the job in-service education and training as a way of
imparting institutional values such as attendance at the workplace in partnership with
recognised labour representatives through bilateral and multilateral forums and through
institutional skills development committee which should be representative of all
stakeholders with the view to promote stability in the workplace and indirectly enhance
productivity and reduce workplace absenteeism Currently the bilateral multilateral and
skills development committees are inactive in the institutions that were targeted and
management seems to be intimidated by the militant labour representatives
High levels of absenteeism among some occupational groups do suggest a need for an active
employee assistance programmes at all hospitals Employee wellness committees are
currently inactive There is a sporadic intervention approach at some institutions where
PILIR Committees are active Employee assistance programmes should be budgeted for as a
standing on-going programme in all hospitals There is a need for a thorough research as to
why absenteeism remains high in the public service and focus on absenteeism broadly
73
BIBLIOGRAPHY
African National Congress 1994 A national health plan for South Africa Johannesburg
African National Congress
Allen SG 1984 Trade union absenteeism and exit-voice Industrial and Labour Relations
Review 37 (3 April)
Auriacombe CJ 2001 Guidelines for drawing up research proposals and preparing
thesesdissertations Pretoria University of South Africa
Amin S Das J amp Goldstein M (eds) 2008 Are you being serviced Newtools measuring
service delivery Washington DC The International Bank for Reconstruction and
DevelopmentThe World Bank
Andrews Y 1997 The personnel function University of Pretoria Kagiso Tertiary
Babbie E 1992The practice of social research6th edition California Wadsworth
Bamford L Klein amp Engelbrecht B 1999 How to monitor and address absenteeism in
district hospitals for sub-district support initiative for sub-district support Cape Town
KWIK-SKWIZ 25 Press Gang
Bangali A 2004 Are older workers genuine assets for economy Strategies and possibilities
for effective use of their human resource potentialTuebingen Eberhard Karls University
Barker F2007The South African labour market theory and practice5th edition Pretoria
Van Schaik
Bendix S 2000 Industrial relations in South Africa4th revised edition Lansdowne Juta
Bergdahl M 2001 How-Malrt minimises business with HR practices Human Resource
Development Gauteng College Regional Academy Leadership Journal 6
Breetzke A 2009 Managing absenteeism Available at httpwwwIrnetworkcoza
(Accessed on 05082009)
Brink H 1996 Fundamentals of research methodology for health care professionals
Kenwyn Juta
74
Brynard PA amp Hanekom SX 2005 Introduction to research in Public Administration and
related academic disciplines Pretoria Van Schaik
Burton JP Lee TW amp Holtom BC 2002The influence of motivation to attend and
organizational commitment on different types of absence of behavioursJournal of
Managerial Issues14 (2)
Buschak M Craven C amp Ledman R 1996 Managing absenteeism for productivity SAM
Advanced Management Journal6 (1)
Camp S amp Lambert EG 2005 The influence of organizational incentives on absenteeism
Sick leave use among correctional workers Available on
httpwwweascnoaagov(Accessed on22052009)
Canadian Nurses Association 2006 Trends in illness and injury ndashrelated absenteeism and
overtime among publicly employed registered nurses Canadian Nurses Association Ottawa
Available on httpwwwcna-aiicca (Accessed on 30032009)
Chaudhury Namp Hammer JS 2003Ghost doctors absenteeism in Bangladeshi health
facilitiesWorld Bank Policy Research Working Paper 3065 May Available
onhttpecoworldbankorg(Accessed on 10072011)
Charted Institute of Personnel and Development 2008Absence managementAnnual survey
report Charted Institute of Personnel and Development July Reference 4513 Available at
httpwwwcipdcouk (Accessed on 10072011)
Cloete JJ 2004South African public administration and management2ndimpression
Pretoria Van Schaik
Clark RL 2007The emergence of phased retirement economic implications and policy
concerns Ontario John Deutsch Institute for the study of economic policy
Dagmara S 2000Whorsquos minding the hospitals Absenteeism soars HampHN Hospitals amp
Health Networks 74 (4) April 14ndash143 Available at httpwwwoasisunisaacza(Accessed on
20072011)
Davey MMamp Cummings G 2009 Predictors of nurse absenteeism in hospitals a
systematic review Journal of Nursing Management 17 312ndash330 Available on httpO-
webebscohostcomoasisunisaacza (Accessed on 30072011)
Department for Public Service and Administration1997White paper on transforming public
service delivery Pretoria Public Service Commission
75
Department of Public Service and Administration 2007 Determination on working time in
the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Determination of leave of absence
in the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Policy and procedures on incapacity
leave for ill-health retirement (PILIR)Pretoria National Office
De Wit P 2006 Reasons for absenteeism in the Department of Defence Pretoria Tshwane
University of Technology
Du Toit Damp Van Der Waldt G 1998 Public management grassroots Cape Town Juta
Du Toit D Knipe A Van Niekerk D Van Der Waldt Gamp Doyle M 2001Service
excellence in governance Cape Town Heinemann
Du Toit D Bosch D Woolfrey D Godfrey S Rossouw T Christie S Cooper C Giles
G amp Bosch C 2003Labour relations law a comprehensive guide4thedition Durban
LexisNexis Butterworths
Erasmus B Swanepoel B Schenk H Van der Westhuizen EJamp Wessels JS 2005 South
African human resource management for the public service Pretoria Juta
European Foundation for the Improvement of Living and Working Conditions
(EFILWC)1997Preventing absenteeism at the workplace Ireland Office for Official
Publication on the European Committee
Fakie SA 2005Report on the Auditor-General on a performance audit of the management
of sick leave benefits at certain national and provincial departments Pretoria Department
Public Service and Administration (DPSA)
Ferguson T D Muedder Kamp Fitzgerald R M2001 The case of total absence
management and integrated benefitsHuman Resource Planning24 (3)
Finnemore M amp Van Rensburg R 2002 Contemporary labour relations Johannesburg
LexisNexis
Gaudine A amp Gregory C2010The accuracy of nursesrsquo estimates of their absenteeism
Journal of Nursing Management 18599ndash605
Gauteng Province 2007 Human Resource Development Strategy for Gauteng for Gauteng
maximizing human capital for shared growth Pretoria Government Printers
76
Gauteng Province 20089 Annual report Pretoria Government Printers
Gauteng Province 2010 Monitoring and Evaluation Policy FrameworkGauteng Provincial
Government Office of the Premier
Ghauri P Gronhaug Kamp Kristianslund I 1995 Research methods in business studies
England Prentice-Hall
Goldsmith Mamp Morgan H 2003 ldquoLeadership is a contact sport The ldquofollow up factorrdquo in
management development The 5th Annual Global Learning SummitResearched and
organised by SALVO 20ndash24Feb
Goldstein M2008Why measure service delivery Are you being serviced New tools for
measuring service deliveryEdited byAmin S Das Jamp Goldstein MWashington DCThe
International Bank for Reconstruction and DevelopmentThe World Bank
Griep RH Rotenberg L Chor D Toivanen SampLandsbergis P2010Beyond simple
approaches to studying the association between work characteristics and absenteeism
Combining the DCS and ERI modelsRoutledge Taylor amp Francis GroupWork ampStress 24 (2
April-June)179ndash195Available athttpwwwinformaworldcom (Accessed on 20072011)
Grogan J 2003 Workplace law 7 th edition Lansdowne Juta
Grogan J 2005 Dismissal discrimination and unfair labour practices Lansdowne Juta
Hirschfield RR Schmitt LPamp Bedeian GA2002 Job-content perceptions performance-
reward expectancies and absenteeism among low-wage public-sector clerical employees
Journal of Business and Psychology 16(4) Human Sciences Press Available on
rhirschfterryugaed(Accessed on 30032009)
Hoxsey D2010Are happy employees healthy employees Researching the effects of
employee engagement on absenteeismCanadian Public Administration53 (4) p551-
571Canada The Institute of Public Administration of Canada
Jacobs EJamp Roodt G 2011 The mediating effect of knowledge sharing between
organisational culture and turnover intentions of professional nursesSouth African Journal
of Information Management
Jankowitz E 1991Terminating for absenteeism practical labour management Rivonia IR
Data Publication 1(10)
Keese M2006 Live longer work longerDELSA Newsletter OECD Available at
httpwwwoecdorgelsemployment(Accessed on 10072011)
77
Lambert EG Camp SD Edwards Camp Saylor WG 2005 Here today gone tomorrow
back again the next day absenteeism and its antecedents among Federal Correctional
staffWashington DC Ohio
Landstad B Vinberg S Ivergard TT Gelin G ampEkholm J2001Change in pattern of
absenteeism as a result of workplace intervention for personnel support Ergonomics
001401391544 (1)
LexisNexis 2006Labour Law Reports July 1994ndashDec2006CumulativeIndex Durban
LexisNexis
LexisNexis 2007 Legislation and strategyLexisNexis (9)Durban Butterworths Available at
httpwwwmylexisnexiscoza (Accessed on 15072011)
Madibana LF 2010 Factors influencing absenteeism amongst professional nurses in
London Pretoria University of South Africa
Markussen S Rogeberg OJ amp Gaure S 2009 The anatomy of absenteeism IZA
Discussion Paper Series No 4240 June Bonn Institute for the Study of Labor
McCormick ET amp Ilgen D1985 Industrial and organizational psychology 8th edition New
Jersey Prentice-Hall
McGoldrick E amp Arrowsmith JJ 2001Discrimination by age the organizational response
Ageism in work and employment Edited by Glover IampMohamed Sterling Management
SeriesEngland University of Sterling
Mellor N Arnold Jamp Gelade G2009The effects of transformational leadership on
employees in four of UK public sector organisations Health and Safety Laboratory for the
Health and Safety Executive UK RR648 Research Report
MINTRAC 2009 Literature review on labour turnover and retention Available at
strategieswwwmintraccom (Accessed on 14042009)
Mouton J2005How to succeed in your Masterrsquos and Doctoral studies a South African guide
and resource book Pretoria Van Schaik
Munro L 2007 Absenteeism and presenteeism possible causes and solutions The South
African Radiographer45(1) Available onhttpsorsaorgza(Accessed on 10072011)
Nel PS Gerber PD Van Dyk PS Haasbroek GD Schultz HB Sono TampWerner A
2001 Human resource management5th edition New York Oxford
Nel PS Kirsten M Swanepoel BJ Erasmus BJampPoisant P 2008South African
employment relations theory and practice6th edition Pretoria Van Schaik
78
Nichols AampEvangelisti W2001 Fitness for work the effect of aging and the benefits of
exerciseSterling management series ageism in work and employmentEdited by Glover
LampMohamed B England University of Sterling
Nyathi MN 2000Factors contributing to absenteeism among nurses a management
perspective Pretoria University of South Africa
Patrick MN 2001Positive psychological functioning among civil servantsPretoria
University of South Africa
Paton N2010 Long-term absence hand in hand Occupational Health Reed Business
Information UK Reed Elsevier Available athttpebscohostcomoasisunisaacza
(Accessed on 10072011)
Parbhoo S2003 Why worry about absenteeism in the workplace CCMA PublicationCCMA
Mail July
Pierce K2009 The impact of absenteeism in the public service in the context of GEMS
Pretoria GEMS Government Employees Medical Scheme [lsquoslrsquo]
Public Service and Co-ordinating Bargaining Council (PSCBC) 2000Resolution 72000
Polit DF amp Hungler BP 1995 Nursing research principles and methods Philadelphia
Lippincott
Pousette A amp Hanse JJ 2002Job characteristics as predictors of ill-health and sickness
absenteeism in different occupational types-a multigroup structural equation modelling
approachNational Institute for working life TaylorampFrancisSweden Goteborg Available on
httpwwwtandfcouk (Accessed on 10072011)
Public Service Commission2002Sick leave trends in the Public Service Pretoria Public
Service Commission
QUALSA Report 2009Policy procedure incapacity leave and ill-health retirement Steering
Committee QUALSA [rsquoslrsquo]
Reday-Mulvey G 2005Working beyond 60 key policies and practices in Europe New York
Palgrave Macmillan
Republic of South Africa 1995 Labour Relations Act 66 of 1995
Republic of South Africa 1997 Basic Conditions of Employment Act 75 of 1997
Republic of South Africa 2001 Public Service Regulation 2001
79
Republic of South Africa 2011 ldquoTowardsquality care for the patientrdquo National Core
Standards for Health Establishments in South Africa Pretoria Government Printers
Robbins SP amp Decenzo DA 2001 Fundamentals of management essential concepts and
applicationsNew Jersey Prentice Hall
Robbins SP Odendaal A amp Roodt G2004Organizationalbehaviour Global Southern
perspective 5th impression Cape Town Pearson
Rogers RE amp Hertin SR 1993Patterns of absenteeism among government employees
Public Personnel Management22 (2)Available at httpwwwquestiacom (Accessed on
10012009)
Serneels P Lindelow MampLievens T2008Qualitative research to prepare quantitative
analysis absenteeism among health workers in two African countriesAre you being
serviced New tools for measuring service deliveryEdited by Amin S Das
JampGoldsteinM2008 The International Bank for Reconstruction and DevelopmentThe
World Bank for Reconstruction and Development Washington D C The World Bank
Slabbert JA amp Swanepoel BJ 2001Introduction to employment relations
managementDurban Butterworths
South African Survey Millennium1999-2000 Johannesburg South African Institute of Race
Relations
Steers RMamp Rhodes SR 1978Major influences on employee attendance a process
model Journal of Applied Psychology63 (4)391-407
Oi-ling S2002Experience before and throughout the nursing careerPredictors of job
satisfaction and absenteeism in two samples of Hong Kong nursesJournal of Advanced
Nursing 40 (2)218ndash229 Available on httpwwwebscohostcomoasisunisaacza
(Accessed on 10072011)
Todd C2001Contract of employment Claremont Siber Ink
Tonya TW2001Minimizing absenteeism in the workplace strategies for nurse managers
Nursing Economics19 (2 MarApril) 53 3 Available at httpwwwoasisunisaacza
(Accessed on 14012009)
Tustin C 1994Industrial relations a psychological approach1st edition Halfway House
Southern Publishers
80
Unruh Jamp Strickland M2007 Nurse absenteeism and workload Negative effect on
restraint use incident reports and mortality JANORIGINAL RESEARCH Journal compilation
Florida Blackwell
Van der Westhuizen C 2006Work related attitudes as predictors of employee absenteeism
Pretoria University of South Africa
Venter R 2003 Labour relations in South AfricaRevised edition Cape Town Oxford
University Press
Viviane IJ 2011Absenteeism among women workers in industry85 IntrsquoLab Rev 248
(1962) Available at httpwwwHeinonlineorg(Accessed on 18052012)
Weeks KL 2004 Development and initial characteristics of a comprehensive survey on
workplace absenteeism Logan Utah State University Available on
httpwwwoasiscomunisaacza(Accessed on 14012009)
Welman JC amp Kruger SJ2001Research methodology for the business and administrative
sciences 2nd edition New York Oxford
Yende PM 2005 Utilising employee assistance programmes to reduce absenteeism in the
workplace JohannesburgUniversity of Johannesburg
81
ANNEXURES A B C
ANNEXURE A
PROCESS EVALUATION QUESTION COMPLIANCE
YESNO
ACTION PLAN
Retention and Reward -
leave
1 Are there complete and
accurate Z 1(Leave application
forms) forms on file
2 Have all application forms been
approved stamped and
registered
3 Have all forms been captured
on the Persal with the following
requirements
Supporting documents
A 10 day compulsory leave
processed within the annual
leave cycle Determination of
Leave
4 The remaining days are utilized
6 months from the end of the
leave cycle
5 Are there unutilized leave days
6 Has there been adequate
checking of leave reasons
Leave credits
Adherence to leave categories
(i)Normal ( ii) Incapacity
(iii) Injury on duty (iv) Maternity
(v)Adoption (vi) Family
responsibility
(vii) Office bearersshop stewards
and Casual Employees
7 Have work reasons been
provided for leave days
(Source Compiled by C S Ndhlovu 2012)
82
ANNEXURE B
Retention and
reward ndashsick leave
Evaluation Question Compliance YesNo Action Plan
1 Are there medical
certificates that have been
submitted to all medical
claims with the following
Specific illness stated
Supporting documents on
file
2 Has the 8 week rule for
36 days in a 3 year cycle
been adhered to
3 Are there complete
medical certificates for 3
days or more sick leave
days for normal sick leave
4 Are all other leave days
above 3 days utilized after
36 days treated as
temporary incapacity
leave
5 Are temporary
incapacity leave forms
submitted within 5 working
days after the first day of
absence
6Is there a register for
temporary incapacity
leave for 1 to 29 days lead
time for reporting leave
applications
7 Has the employer
approveddeclined the
leave application within 30
working days of receipt
(Source Compiled by C S Ndhlovu 2012)
83
ANNEXURE C
CHECK LIST
Is there a leave register in place for all leave applications
1 Is leave approved prior to the employee proceeding on leave
2 Area attendance registers maintained and up to date
3 Are periodic audits for leave carried out
4 Is there evidence of GSSCrsquos approval on leave applications
5 Are leave forms accurately captured on Persal
6 Are leave forms accurately completed by applicants
7 Is movement of leave forms monitored between the GSSC and institutions
8 How is rejected leave application dealt with
(Source Compiled by C S Ndhlovu 2012)
84
4514 Nursing assistants 51
4515 Finance officers 52
4516 Administration staff 52
4517 Administration support 52
452 Race in relation to absenteeism 57
4521 Africans 57
4522 Whites 57
4523 Coloureds 57
4524 Indians 58
453 Tenure range in relation to absenteeism 59
454 Salary range in relation to absenteeism 60
455 Age of full time employees in relation to absenteeism 61
456 Gender in relation to absenteeism 63
457 Week days in relation to occupational groups 64
46 CONCLUSION 66
5 CHAPTER 5 FINDINGS CONCLUSIONS AND RECOMMENDATIONS 67
51 INTRODUCTION 67
52 FINDINGS 67
53 CONCLUSIONS 71
54 RECOMMENDATIONS 72
BIBLIOGRAPHY 74
ANNEXURES A B Chelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip82
VIII
LIST OF FIGURES
FIGURE 21 CONCEPTUAL FRAMEWORK MODELhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
FIGURE 22 MODEL SPECIFICATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
FIGURE 41 INTEGRATED ORGANISATIONAL STRUCTUREhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip53
AS REPRESENTED BY THE HOSPITALS
FIGURE 44 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip58
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip60
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip61
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALShelliphelliphelliphelliphellip62
FIGURE 48 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip64
X
LIST OF TABLES
Table 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
Table 2 COMPARISONS OF NUMBERS OF ADMINISTRATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
AND SUPPORT STAFF IN THE DIFFERENT HOSPITALS
Table 3 GENDER COMPARISON IN DIFFERENT HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Table 4 COMPARISON OF TENURE OF SERVICE IN RELATION TOhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
ABSENTEEISM IN THE FOUR HOSPITALS
Table 5 COMPARISON OF THE OCCUPATIONAL GROUPShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip45
IN THE DIFFERENT HOSPITALS
Table 6 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip48
Table 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Table 8 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip54
(SALARY RANGE 1-12)
Table 9 AGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip55
Table 10 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Table 11 WEEK DAYS IN RELATION TO ABSENTEEISM INhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip65
THE FOUR HOSPITALS
Table 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphellip66
IX
CHAPTER 1
GENERAL INTRODUCTION
11 INTRODUCTION
The Gauteng Province is viewed as a province of opportunities by South Africans as well the
neighbouring countries such as Mozambique and Zimbabwe The impact of these
perceptions has placed a heavy demand on services including health provided within the
confines of the province the results being an increase in the workload of the employees
The indirect results of the increase in the workload have been unacceptably high levels of
absenteeism seemingly sub-standard levels of health care and high cost of delivering the
health care services Absenteeism poses a threat and can lead to the collapse of health care
services if absenteeism is poorly managed The research examines the management and
control of absenteeism in four out of thirty four hospitals that service the province The
hospitals that have been targeted for the research are ODI District Hospital Germiston
Hospital TARA Moross Centre Hospital and George Mukhari Hospital
This chapter explains the background and motivation for the research The research
highlights the problem statement which focuses on the effective management of
absenteeism The objectives of the study the research methodology and structure of the
research are explained The relevant literature review was consulted for the research The
key concepts that are used in the research are conceptually defined The research design is
a descriptive stratified random survey The data that were used were collected in three
phases the unit of analysis were the employees of the Gauteng Department of Health in the
four target hospitals and the unit of observations were observations of the employees of
the four hospitals The construct of validity was achieved through using a variety of data
collection methods Ethical considerations were taken into account during the research
process Limitations of the research were imposed by the uniqueness of each of the target
hospitals The structure of the research and the reference technique is explained in this
chapter The research on absenteeism in the Gauteng Department of Health is confined to
the period of 1 January 2008 to 31 December 2008 and focused on the working-man days
lost how absenteeism is managed and employee well-being and rehabilitation
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH
The Gauteng Department of Health received a qualified report in 2008 on the control of sick
leave A performance audit was conducted by the Public Service Commission (PSC) (2002
xvi) into the information required to effectively manage sick leave in the public service
1
The research on absenteeism in Gauteng Department of Health seeks to examine the extent
of workplace absenteeism in the ODI District Hospital which is in a transitional stage from
North West to the Gauteng Province The hospital falls under Tshwane Metropolitan
Municipality and is in Region C The Germiston Hospital falls under Ekurhuleni Metropolitan
Municipality in Region B TARA Moross Centre Hospital is in Region A under the
Johannesburg Metropolitan Municipality and George Mukhari Academic Hospital is Region C
under the Tshwane Metropolitan Municipality The research seeks to examine the degree of
compliance by the four hospitals with the recommendations of the performance audit of
management of sick leave in the light of the qualified report received by the Gauteng
Department of Health (Human Resources) in 20089
13 PROBLEM STATEMENT
The Gauteng Department of Health provides health care services as the core business of the
Department The Health care services are labour intensive and high levels of absenteeism by
its employees undermine the Departmental efforts to deliver quality health care to the
people of Gauteng The problem statement therefore is to examine to what extent the
effective management of absenteeism can enhance the effectiveness of the Gauteng
Department of Health
14 AIM AND OBJECTIVES OF THE RESEARCH
The aim and objectives of the research are explained in this section
141 AIM
The aim of the research is to determine how the effective management of absenteeism can
contribute to the effective health care of Gautengrsquos communities
142 Objectives
The objectives of the study are
to determine the impact of the variables such as age gender occupational category
and salary level on workplace absenteeism
to determine whether the correlation between absenteeism levels and tenure of
service does exist
to determine trends of workplace absenteeism in different employee categories and
to establish the different challenges confronting the different hospitals in
management and control of absenteeism in terms of size complexity and location
2
15 LITERATURE REVIEW
Various studies have been conducted to examine workplace absenteeism in different fields
in government and private institutions Van Der Westhuizen (200636) research focused on
high and low combinations of job involvement and organisational commitment The
outcome was not emphatic on the findings as predictors of the turnover and absenteeism
The research noted that women are more absent from the workplace than men De Wit
(2006) focused on the nature of absenteeism the impact of absenteeism on the
organisation reasons for and causes of absenteeism and measurement of absenteeism and
the findings were not able to find a high coefficient in the test sample
Camp and Lambert (20054) found that the use of sick leave as an incentive to reduce sick
leave by the employees under the Civil Service Retirement System (CSRS) led to a reduction
of absenteeism as a result of sick leave when compared with employees who functioned
under the conditions of the Federal Employees Retirement System (FERS) who within the
same company lost the unused sick leave when they retired
Ferguson Ferguson Muedder and Fitzgerald (200138) focused on the impact of
absenteeism and cost in terms of time lost in the Total Absence Management (TAM)
concept and found that the aging employee exposes institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods of
time
Serneels Lindelow and Lievens (2008210) claim absenteeism is high among employees in
the public sector in developing countries due to a lack of accountability and a lack of
punishment for transgression
The research seeks to determine the extent of the problem of workplace absenteeism its
impact and management in the identified hospitals It seeks to establish the relationship if
any between the various variables and absenteeism such as age occupation tenure salary
level gender and race
16 TERMINOLOGY
Key concepts that are used in the research are conceptually defined however a
comprehensive concept clarification will be done in chapter 2
Workplace absenteeism Workplace absenteeism is the absence of employee at the
workplace that is defined by Du Toit and Van Der Waldt in (1998139) as the place that the
institution makes available and where officials have to perform their work
3
Workplace forms part of the internal environment for public administration in the public
service Robbins Odendaal and Roodt (200415) define absenteeism as the failure of an
employee to report for work as scheduled regardless of the reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work According to
Venter (2003267) desertion occurs when the employee leaves the place of employment
without the intention to return to work
Employee An employee is defined as any person employed in terms of the Public Service
Act 1994 irrespective of rank or position (Public Service Act 1994 Subsection 15) Todd
(20011) refers to an employee as any person excluding an independent contractor who
works for another person and is entitled to be paid for it or who in any manner assists in
carrying on or conduct the business of the employer Bendix (2000123) defines an
employee as a person in a workplace except a ldquosenior managerial employeerdquo whose status
and contract of service grants the employee the authority to represent the employer in
interactions with the workplace forum to determine policy on behalf of the employer and
make decisions which might conflict with representation of workers at the workplace
Employer An employer as an individual person who may be the employer in legal terms as
well as the organisation which is responsible for implementing Public Service human
resource management policies (RSA 1997 Section 15)
Leave cycle The Public Service Act 1994 refers to the leave cycle as 36 months employment
with the same employer
Quality Is defined as getting the best results possible within the available resources (RSA
2011)
Standard Is a statement of an expected level of quality delivery A standard reflects the
ideal performance level of a health establishment in providing quality care (RSA 2011)
17 RESEARCH DESIGN AND METHODOLOGY
This section deals with the research design and methodology
171 Research design
Research design is the overall plan for relating the conceptual problem to relevant empirical
research It is a quantitative descriptive research that involves the systematic collection of
numerical information under conditions of considerable control (Polit amp Hungler 1994
24175)
4
The choice of the research design influences subsequent research activities such as
identifying the target subjects what data to collect and how they should be collected The
research design is a descriptive stratified random survey which is concerned with
characteristics of a specific population subject at a fixed point in time for comparative
purposes The focus is on a representative sample of the relevant population It is concerned
with the accuracy of the findings and their generalisability The survey is used to gain deeper
insight of the behaviour of employees with regards to motivation satisfaction and
grievances (Babbie 199289 Ghauri Gronhaug amp Kristianslund 199527 60 Brink 199611
6 Welman Kruger amp Mitchell 200152)
172 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services Four hospitals of the thirty four health care delivery institutions have been
identified for the research
Each hospital is unique in its character in terms of specialisation of health care delivery
service The four hospitals are located in Tshwane Johannesburg and Ekurhuleni
Metropolitan Municipalities The sample is a stratified random sampling which is composed
of various clearly recognisable non-overlapping sub-populations (strata) that differ from
one another mutually in terms of variables that are a combination of more than one
variable such as age sex income level or educational level The purpose is to ensure that
every part of the population (every stratum) is represented The members of a particular
stratum are homogeneous in the population at large The sample is representative of a
population with clearly distinguishable strata with a greater degree of certainty (Babbie
199267 Brynard amp Hanekom 200544 Ghauri et al 199578 Brink 1996138 Welman amp
Kruger 200155-56 Welman et al 201061 Polit and Hungler 199518) The data were
collected in three phases
The first phase of data collection was done through auditing of hard copies of identified
personnel files representing ten files per hospital and using the tool in annexure A amp B The
forty employeesrsquo profiles were accessed through the Human Resource Information
Management system (HRIM) located in the Gauteng Department of Health Head Office The
respective employeesrsquo profiles were handed over to the human resource manager in the
respective hospitals on the morning of the audit for the human resource practitioner to
draw out the hard copy files for auditing The characteristics of the individuals that were
identified for the first phase were males and females and the different race groups The
auditing of the files was for the complete working life of the employees and not confined to
2008 only Registers that are used by the human resource administration to control the
movement of the leave forms were inspected as evidence of the control system in place
5
The purpose of auditing the files is to gain insight into how leave in general was captured
managed and controlled by the hospitals The second phase of data collection was done
through structured interviews with the four human resource managers who were directly
accountable for management and control of leave of absence in general in the four
hospitals
A structured interview provides for a more organised approach and a more stable basis for
assessment of the different candidates (Erasmus Swanepoel Schenk Van der Westhuizen amp
Wessels 2005250) The structured interview was conducted using the tool in annexure C
Tara Moross Centre Hospital had been functioning without a manager in human resource
and the manager that was interviewed had been in the post for three months The human
resource practitioner who was at salary level 8 acting in the Assistant Directorrsquos post
(manager) was invited to join the manager and be part of the structured interview ODI
District Hospital had three human resource practitioners including the accounting officer at
level 8 and in an acting capacity
The third phase of data collection was through the Human Resource Information
Management (HRIM) This system used Personnel Remuneration Administration System
(PERSAL) to collect data Data in this system are categorised in salary level date of
appointment occupational category gender age in units of five race employing hospital
employment status in different categories such as session contract and full-time and the
different types of leave of absence
The research used primary and secondary data in analysing sick leave utilised by full time
employees in the identified hospitals for the period of 1 January to 31 December 2008 using
the Personnel Remuneration Administration System The total population sample was four
thousands and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range at level 1 to 12
The research used past events such as sick leave utilised by employees using secondary
data from Personnel Remuneration Administration System falling into the category of a
historical empirical research The interval scale of measurement was used in the
quantitative research and actual numbers are ordered with equal measurement between
each category (Brink 1996 149 Brynard amp Hanekom 2005 28-29 Mouton 2005
52100170)
6
173 Unit of analysis
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the research refers to observation of work attendance by
the employees of Gauteng Department of Health in the four hospitals
The observation deals with the historical events such as employees who have already
utilised sick leave in the workplace The subjects that are studied are the core health care
providers such as doctors nurses and support employees such as allied administration and
administration support (Mouton 200551-52 Welman et al 2001 52-53)
174 Unit of observations
The observations that are made are of health care workers and support teams in Tara
Hospital Germiston Hospital ODI Hospital and George Mukhari Hospitals The unit of
observations describes the characteristics of a large number of individual people such as
gender age salary range occupational category tenure of service and race in relation to
absenteeism in the workplace In the descriptive research the individual characteristics are
aggregated for the purpose of describing a larger group (Babbie 199292)
18 CONSTRUCT VALIDITY
Construct validity is concerned with the question what construct is the instrument actually
measuring(Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with the four accounting officers in leave management The third phase was collecting of
personnel data through the Persal system
19 ETHICAL CONSIDERATIONS
Ethical considerations included among other issues the protection of the unit of analysis and
unit of observations from discomfort and harm by not revealing information which can
cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity Anonymity is achieved
when the researcher cannot link a given response with a given respondent and reporting
aggregate data only When data are collected at one sitting and not over a period of time
makes it possible to achieve anonymity as the need for follow up is eliminated Subjects of
observations are selected for reasons directly related to the problem being studied as the
principle of justice
7
Confidentiality is about the researcherrsquos responsibility to protect all data gathered within
the scope of the research and shared only with people involved in the research (Babbie
1992465ndash466 Brink 199640ndash41 45)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous The interview was part of the actual audit
that was done as part of monitoring and evaluation that was in progress in the Department
of Health following a negative auditor generalrsquos report about management of leave in
general The managers were put at ease as they were given the check list afterwards for
self-monitoring for future self-auditing
The data that were collected through Personnel Remuneration Administration System
(Persal) identified employees through the Persal number and kept their identity anonymous
The data that were collected through the hard copy of employeesrsquo files were used to point
out areas of concern to the managers and the files did not leave the office of the manager
at the end of the process once more protecting the identity of the employee
110 LIMITATIONS OF THE RESEARCH
The research was conducted on four hospitals of different sizes specialisation and three
metropolitans with unique challenges The period of the research was confined to a
calendar year (2008) and not a financial year The focus was on absenteeism due to sick
leave of full time employees There is no distinction that is drawn between the working-man
days that are lost between shift and non-shift workers The findings may be different if all
absenteeism of employees at the time were considered for the research
111 STRUCTURE OF THE RESEARCH
Chapter 1 It provides a general introduction to the research It includes an introduction the
background and motivation for the research that provides the context the problem
statement and the significance of the research The key concepts are defined The research
design the method of data collection the sampling method data analysis and
interpretation limitations to the research are explained in this chapter
Chapter 2 This chapter considers the theoretical foundations concepts characteristics
theories approaches and classifications of workplace absenteeism Conceptual framework
of absenteeism predictors of absenteeism and various models of absenteeism are
explained Measures to control workplace absenteeism the impact of absenteeism in the
institution and management intervention strategies are explained
Chapter 3 It describes the research design different aspects of the research methods
applied and the data collection techniques used unit of analysis units of observations
construct validity and ethical considerations
8
Chapter 4 This chapter provides the organisational structure of the Gauteng Department of
Health comparisons of hospital employees different race groups of the four hospitals
gender comparisons in different hospitals and comparisons of the different occupational
groups It provides a short description of the target hospitals The research interpretation is
discussed in terms of the different occupational groups and absenteeism different races
and absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism
The week days absenteeism pattern and contributions by the four hospitals to absenteeism
are presented in this chapter
Chapter 5 It provides a discussion of the research evaluation of workplace absenteeism
findings recommendations and limitations
112 REFERENCE TECHNIQUE
The reference technique that is applied in the research involves all sources that have been
consulted while doing the research When legislation is used as a source of information
reference to the specific act is used
113 CONCLUSION
Chapter 1 provides a discussion on the background and motivation of the research problem
statement and the objectives The significance of the research in South African public
institutions and private institutions of other countries and the possible contribution of the
study are explored The terminology that is used in the research is contextualised for the
purpose of the research The research design and methodology are presented in this
chapter The units of analysis the units of observation construct validity ethical
considerations and limitations to the research are also presented in this chapter
The next chapter discusses the theories of absenteeism
9
CHAPTER 2
MANAGING ABSENTEEISM
21 INTRODUCTION
The Gauteng Department of Health is classified as a public institution whose existence is
justified on the grounds that it renders health care services to the public The health care
system is encouraged to develop delivery systems and practices that are in line with
international standards management practices that promote efficient and compassionate
delivery of services and ensures respect for human rights and accountability to the public
(African National Congress 199443-44) This objective can only be achieved if the resources
to provide such services are available The human resources are a vital factor for the health
care sector as it is labour intensive Public institutions such as the Gauteng Department of
Health are funded from public funds and if the human resources do not report for work
service delivery is compromised and the cost to the department in the form of salary
expenditure becomes exorbitant as the department must find replacement staff and pay
for overtime as well It is when all these factors are taken into consideration that workplace
absenteeism becomes a cause for concern for the Gauteng Department of Health
In this chapter absenteeism is discussed from a theoretical perspective and informed by
literature review The classification of workplace absenteeism theoretical perspective
definitions dimensions of employment relationship conceptual framework of absenteeism
structural model of absenteeism legislative framework that regulates the employment
relationship and intervention strategies to control workplace absenteeism are explored
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM
According to Viviane (20111) the term absenteeism was first used in Britain during the
First World War in dealing with employed persons It is during the times when production is
of pressing national importance that the absence of employees from the workplace is keenly
felt Absenteeism is considered a good barometer of staff morale an indirect measure of
employeesrsquo health and well-being and is found to be associated with health-related
absences from work Employees who are motivated and committed to their work and
employer have to be very sick before they book off sick (Griep Rotenberg Chor Toivanen amp
Landsbergis 2010179)
McCormick and Ilgen (198556-57) describe job attendance criteria as relating to a tendency
of employees to withdraw from or attend to their jobs The criteria identified were job
tenure occupational category absenteeism and tardiness According to Markussen
Rogeberg and Gaure (20096) employee characteristics such as age gender education and
occupation have a substantial impact on absence behaviour
10
Chaudhury and Hammer (20033) identified that medical skills and nursing skills are
marketable and greatly in demand Doctors and nurses used this opportunity to make
money and work as private health care providers as well as public health care providers
holding two jobs The absence is considered in terms of morning or afternoon absence by
these categories as they are viewed as having a great deal of discretion over where and
when to discharge their public responsibilities The criteria identified were job tenure
absenteeism and tardiness
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) refer to absenteeism
as non-attendance when an employee is scheduled to work The theoretical perspective of
absenteeism takes into account the physical and or psychological absence of the employee
from the workplace or work station at a time when the employee is contractually expected
to be at the workplace According to Andrews (199734-35) the behaviour and actions of
public officials are determined by specific ethical codes of conduct and it is assumed that
their actions are for the benefit of the communities that are serviced by the public officials
Social ethics focus on how the clients of the Department are treated and are therefore
concerned with the impact of decisions on people inside and outside the institution
individually and collectively
Grogan (2005237) states that employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
look for trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
2001 section F(c) In the public sector contractual employee benefits are modified by
collective agreements These benefits are material gains for the employees and have a
monetary value and a cost factor to the employer
The contract of employment often includes insured benefits such as incapacity ill health
and early retirement as the total package other than the remuneration for the time worked
as it is intended to attract retain and motivate employees (Breetzke 20091 Ferguson et al
200137 LexisNexis 2006670 LexisNexis 2007176 Markussen Rogeberg amp Gaure 20093
Tustin 199452) The policy on Determination on Leave of Absence requires a medical
certificate for sick leave of three or more days and for every sick leave day utilised when the
eight week rule has been transgressed (DPSA 2009 Section 14 subsection 147)
Political ideologies influence the work environment resulting in some areas being highly
unionised where unions are perceived to be capable of exerting control over the employer
and employee relations for the primary benefit of the employees
11
It is the work environment which is highly unionised that is characterised by high workplace
absenteeism (Andrews 199736 Breetzke 20091 Du Toit amp Van Der Waldt 1998170139
Tustin 199452) Allen (1984331) claims that union members might be absent more
frequently from the workplace than non-members because they face smaller penalties for
absenteeism According to Markussen et al (20095 21) workplace environments do have an
impact on absenteeism and are influenced by social interaction processes among
colleagues Absenteeism is affected by social norms Workplaces with high employee
turnover rate tend to have high absenteeism The turnover rate is defined on a quarterly
basis as Min (number of entries number of existing persons) divided by the number of
employees at the start of the quarter The Charted Institute of Personnel and Development
(CIPD) (200811) claim that the 2006 survey of absence management portrays the public
sector employees as less likely to be dismissed for reasons of workplace absenteeism A
report by the National Institute of Labour Studies (Tonya 20011) found the rate of
absenteeism increased among full-time employees from 2 4 to 25 within two years
The services that are provided by the Department of Health are divided into two distinct
categories Direct services are those services that are rendered to the clients who are
patients who receive medical treatment from the core employees usually referred to as line
functionaries Direct services can only become effective and efficient when supported by
the services of the support staff that provide indirect health care services When employees
do not present themselves for work when scheduled to work and do so on a regular basis
the situation becomes habitual absenteeism (Du Toit amp Van Der Waldt 199818) The
Gauteng Department of Healthrsquos core function is to provide health care services to the
people of Gauteng Province The provision of health care services is labour intensive and
requires large numbers of personnel for effective service delivery
The workplace which may be physical or virtual for the public service employees represent
the internal environment of the institution The employer who is represented by the
manager determines the workplace for employees
Rogers and Hertin (1993217) explain the Decision Model Theory as a conscious decision by
the employee to stay away from work or come to work based on which motivation is
stronger at that moment It is not based on the ability to come to work
Serneels et al (2008210) claim that absenteeism is rife in the public sector especially where
employees hold two jobs The actions of public officials in the performance of their duties
should be ethically justified as it impacts on the decisions of people within and without the
institution individually and collectively Tension and job insecurity in the workplace
manifests as absenteeism (Andrews 199733-137)
12
Frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased staff
morale and high cost to health care (Davey amp Cummings 2009312-313) It is suggested that
on average health care workers are likely to be absent from work as a result of illness or
injury rather than other occupations Dagmara (20002) states that absenteeism may be a
benchmark of what is happening in the hospital setting Absenteeism is defined as habitually
not coming to work when scheduled to It is an indicator of psychological medical or social
adjustment to work
Absenteeism is measured by frequency or duration of work-days missed Frequency
measures provide a reasonable index of voluntary absenteeism whereby each incidence or
episode of absence is counted regardless of the duration of absence It is defined as the
number of days absent over a given period of time Other measures used were total days
duration and percentage Duration measures provide an index of involuntary absenteeism
such as time lost index To assess absence duration the total number of days is tallied
regardless of the number of incidents (Davey amp Cummings 2009313) High workload is
identified as one of the factors that affect absenteeism rate among health care workers
(Oi-ling 20023)
Workplace absenteeism is costly for an institution in terms of lost working-man days hiring
of staff to close the shortage absent or sub-standard service delivery and poor quality of
services The total cost of employment risk approach is about the estimation of the possible
cost of any absent employee to an institution per hour The annual cost to the institutions
per employee is in terms of direct and indirect costs such as overtime low productivity and
a decline in morale among workers who are expected to cover for an absent employee
(Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
The public service employees enjoy security of tenure which may be a contributory factor
of absence from work without good cause This practice is fostered by the knowledge that
they cannot be easily dismissed from their jobs therefore have the belief it is right to stay
away from work Misuse of sick leave is considered to be an overriding problem in instances
where the employee does not uphold the standard of honesty and incorruptibility or these
values are not considered to be the corporate values and norms of the institution (Andrews
1997 221-222 MINTRAC 20093)
Bangali (20043-5) describes age function in the sociological theory as a natural
characteristic of human beings but also an integral aspect belonging to the structure of the
society The age definition in the labour market is influenced by the structural functionalism
The employees age is categorised in the workplace in terms of functions to be performed
be it physical or intellectual The age group of 35 years to 49 years old employees comprise
the largest age group in the labour market
13
The employees who are less than 20 years of age reflect the highest absenteeism rate while
employees above 50 years of age reflect a decrease in the absenteeism rate The
disadvantage of the older workers is that their disabilities last longer once they are injured
and are more likely to be absent as frequently and more likely to be injured than younger
workers Keese (20062) states that ageism is evident in the public service and describes the
age group 25 years to 49 years old as prime age Rogers and Hertin (1993219) found a
significant correlation between the use of sick leave and age Employees with advanced age
used comparatively more sick leave in comparison with the younger employees The
Canadian Nurses Association (20065) noted a reduction in workplace absenteeism rate
among nurses who are less than 45 years of age and an increase in the absenteeism rate
among nurses above 55 years of age
Camp and Lambert (20054) found that the use of sick leave retention as an incentive to
reduce use of sick leave by the employees under the Civil Service Retirement System (CSRS)
leads to a reduction of absenteeism as a result of sick leave compared to the Federal
Employees Retirement System (FERS) who within the same company lost the unused sick
leave when they retired The Employees Retirement System (FERS) applies the same
principle of handling sick leave as the Gauteng Department of Health in the sense that
unused sick leave is forfeited at the end of the three year cycle (DPSA 2009Section 14)
Unruh and Strickland (2007674) found that absenteeism from the workplace does
contribute to a vicious cycle of a negative work environment which leads to more
absenteeism and increased turnover Absenteeism has been found to be higher in
employees who are over 50 years of age and the phenomenon is attributed to age and
changing abilities that increase when work is performed on a full time basis Part-time
arrangements reduce absenteeism as well as the cost of paying for a senior employee even
if seniority is just in tenure Age has been linked to a negative turnover in an institution The
older employee is less likely to leave the organisation An institution is healthier for a spread
of ages Some organisations consider employees to be older in batches or cohorts of five
such as 40 years to 44 years up to 64 years (Nichols amp Evangelisti 2001285 McGoldrick amp
Arrowsmith 200184 MINTRAC 20093 Reday-Mulvey 200579-194)
MINTRAC (20094-8) states that gender moderates the age turnover relationship Women
are more likely to remain in their jobs the older they get than men do Turnover is
occasionally related or preceded by high workplace absenteeism The occupational category
is linked to skill levels and salary levels The lower skill employees are concentrated in the
lower skill occupations and easily replaceable
14
Hirschfield Schmitt and Bedeian (2002553) conducted a research on low-wage public
sector clerical employees and found that those employees who perceived limited
performance-reward expectancies were likely to be absent more often The link between
skilled employees and absenteeism suggested that employees may have utilised
absenteeism as a means of compensating for perceived workplace contributions not
extrinsically rewarded
According to Gaudine and Gregory (2010599) the Canadian Institute for Health Information
(2007) found that absenteeism was a problem among health care workers in comparison to
other employees in other sectors Unruh et al (2007673) found the combination of high
registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery Markussen et al (200921) claim that the type of occupation an
employee is engaged in has an impact on absenteeism
221 Classification of absenteeism
The employees of the Gauteng province and their attendance at work are the focal point of
the province in relation to service delivery that is customer focused Health care services are
labour intensive and require employees to be at work when scheduled to do so (Gauteng
Province 201015) Workplace absenteeism can present in different forms and levels as a
result of a combination of variables (Andrews 19975 Breetzke 20091) McCormick and
Ilgen (198557) and Davey and Cummings (2009313) classify absenteeism as voluntary
when the absence is based on the conscious decision by the health care giver to withhold
contractual services The absence is uncertified unauthorised and unexcused while
involuntary absenteeism occurs for reasons beyond the control of the health care giver
such as illness injury or family responsibility Employers are challenged with the task of
differentiating between the absence due to elective workplace absence and absence due to
illness incapacity The differentiation is based on whether the illness incapacity is validated
by a legitimate medical certificate in terms of the prescript of section 23 of the Basic
Conditions of Employment Act (BCEA) 75 of 1997 (RSA 1997)
222 Definition of key concepts
Concepts are defined for common understanding in the context of the study
Workplace absenteeism Workplace absenteeism is absence of the employee at the
workplace that is defined by Du Toit and Van Der Waldt (1998139) as the place that the
institution makes available and where officials have to perform their work It forms part of
the internal environment for public administration in the public service Bamford Klein and
Engelbrecht (199911) refer to absenteeism as employees taking time off that has not been
scheduled
15
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) claim that
absenteeism is non-attendance when an employee is scheduled to work The European
Foundation (199711) views absenteeism as temporary or permanent incapacity for work as
a result of sickness or infirmity According to Robbins Odendaal amp Roodt (200415)
absenteeism is a failure of an employee to report for work as scheduled regardless of the
reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work The employee
should actually intimate expressly or by implication the intention not to return to work
According to Venter (2003267) desertion occurs when the employee leaves the place of
employment without the intention to return to work
Employee The Basic Conditions of Employment Act no 75 of 1997 Section 1 (a) (RSA 1997)
and Todd (20011) refers to an employee as any person excluding an independent
contractor who works for another person and is entitled to be paid for it or who in any
manner assists in carrying on or conduct the business of the employer The courts use the
control test which identified employees on the basis that they were part of the employer
organisation Bendix (2000123) claims that an employee is a person in a workplace except a
senior managerial employee whose status and contract of service grants the employee the
authority to represent the employer in interactions with the workplace forum to determine
policy on behalf of the employer and make decisions which might conflict with
representation of employees at the workplace Du Toit Bosch Woolfrey Godfrey Rossouw
Christie Cooper Giles and Bosch (200368) state that an employee is a person who works
for a single employer in a permanent fulltime capacity is subject to the supervision of the
employer and receives regular monthly or weekly remuneration and is obliged during
working hours to place his or her productive capacity at the employerrsquos prescribed disposal
Employer
Bendix (2000129) defines an employer as any person except an independent contractor
working for another person or the State and who receives remuneration or any manner
assists in carrying out or conducting the business of an employer DPSA (PILIR) (20094)
states that an employer is the Head of Department or a designated office which will be
responsible for the handling and investigation of incapacity leave applications and ill- health
retirement applications
16
23 EMPLOYMENT RELATIONSHIPS
The employment relationship is about balancing the simultaneous convergent and divergent
interests of the employer and the employee in a regulated manner with the aim of getting
the work of the institution done According to Erasmus et al (2005442) an employment
relationship exists when an individual is employed by someone else to be available to work
for that person in exchange for some remuneration It is through this employment
relationship that reciprocal rights and obligations are created between the employer and
the employee The employment relationship is conflictual in nature (Andrews 199736) The
employees through this relationship are enabled to gain access to the rights and benefits
associated with their employment The Labour Relations Act no 66 of 1995 (RSA 1995)
regulates the management of the conflict in the employment relationship through dispute
resolution structures such as the Commission for Conciliation Mediation and Arbitration
(CCMA) Labour Court and Labour Appeal Court when internal processes fail to resolve the
conflict The employment relationship can be traditional or typical and terms and conditions
of service of employment are regulated by collective agreements This is a tacit
acknowledgement of the existence of a typical employment relation
231 Employment relationship as a multi-dimensional phenomenon
Industrial relations and human resource management are bound together by the
employment relationship through labour employer and industrial relation triangle The
employment relationship is characterised by various dimensions as is the case in a broader
society The dimensions are economic legal individual collective and psycho-social (Grogan
200347)
2311 Economic dimensions
The economic dimension arises through the provision of labour by the employee in the form
of skill knowledge energy abilities and productive time to the employer in exchange for
remuneration Barker (200779) states that a reduction in working hours increases the
hourly cost of production in a unit unless there is a commensurate increase in productivity
The economic dimension is highly regulated The contract of employment includes insured
benefits such as incapacity ill health and early retirement The tendering of services by the
employees is a prerequisite to the employeersquos right to claim remuneration (Grogan
200347) According to LexisNexis (2007176) and the Public Service Regulations 2001
Section E E1 the actual contractual benefits are modified by collective agreements in the
public service sector Employee benefits are material gains for employees that have
monetary value and are a cost factor to the employer The Public Service Regulation 2001
Section F (a) states that the Head of Department shall promote economic and efficient use
of resource to improve the functioning of the public service (RSA 2001)
17
According to Ferguson et al (200137) and Erasmus et al (2005380) employee benefits are
the total compensation package other than the pay for time worked offered to employees
either partially or completely funded by the employer contributions In 2006 about R19
billion was lost on account of absenteeism from sick leave (LexisNexis 2006670 Patrick
2001 17)
Employee benefits are intended to attract retain and motivate employees Some of the
benefits offered to employees are mandated by law such as minimum leave provision as
contained in the Basic Conditions of Employment Act 75 of 1997 and Resolution 72000 of
the Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
2312 Legal dimension
The Labour Relations Act 66 of 1995 Section 3 of Schedule 8 requires that while employees
should be protected from arbitrary action employers are entitled to satisfactory conduct
and work performance from their employees The legal framework provides for the
regulatory requirements for human resource management in the working environment
Grogan (200347) and Grogan (2005120) view the employment relationship as formalised
by a legally binding agreement which is the contract The contract is regulated by specific
laws and formal rules with all the inherent rights and responsibilities to the employer and
the employee In terms of the employment contract one of the responsibilities of the
employee is to render service to the employer at specified agreed upon time except where
the employer has authorised the absence of the employee from the workplace Employees
have a fundamental duty to render services and the employer has a right to expect the
employees to tender such services A basic element of the duty to render service is that the
employee must be at the workplace at the specified agreed upon times unless there is
adequate reason to be absent Bendix (2000120) states that a contract is subject to the
terms and conditions of collective agreements The contract is subject to automatic changes
whenever a new collective agreement is in place The contract and its inherent benefits are
breached by elective absence behaviour of the employee The legal dimension has an
impact on the individual dimension
2313 Individual dimension
The employee enters into a working contract with the employer on an individual basis The
contents of the contract are subject to the Basic Conditions of the Employment Act 75 of
1997 The terms and conditions of employment in the public service are subject to collective
bargaining and collective agreements which influence the employment contract in the
Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
18
The contract of employment is entered into between the employer and the employee under
the supervision of the employer and for remuneration purposes
2314 Collective dimension
According to Slabbert and Swanepoel (20017) the collective dimension of the employment
relationship refers to the organised group aspect of the employment relationship which is
between labour as a group and employers and or their representative public sector
institutions The collective dimension aspect of employment relationship pertains to
legislation relating to bargaining dispute resolution and industrial action
2315 Psycho-social dimension
The psycho-social dimension of the employment relationship represents the unexpressed
needs and expectations of the employer and employees It refers to behaviour in the public
sector institutions within the context of the collective dimension (Davey amp Cumming 2009
313 Erasmus et al (2005442) The Public Service Regulation 2001 Section B states that the
Head of Department shall determine the working time of employees and take into
consideration their personal circumstances which have a social dimension (RSA 2001)
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM
Davey and Cummings (2009322) amalgamated two theories to create a theoretical
framework with the premise that employee attendance is based on two factors the ability
to attend and motivation to attend The theoretical framework focuses on individual work
ethics demographics and from the work environment Some form of absenteeism may be
difficult to prove in a situation where the employer has two or more operational stations or
the employee occasionally operates from a virtual office The duty to render service is
breached by the employee when the employee is physically present and mentally absent as
would be the case of sleeping on duty Workplace absenteeism is multi-dimensional such as
changes in the work environment that overburden the coping mechanism As a result of this
approach a multi-dimensional framework of absenteeism clouds the causative factors of
absenteeism (Breetzke 20091 Patrick 200124 Tustin 199452)
19
FIGURE 21 CONCEPTUAL FRAMEWORK MODEL
(Adapted from Davey amp Cummings 2009320)
The conceptual model uses individual predictors of absenteeism such as age salary level
tenure race gender occupation educational level job satisfaction and organisational
commitment ability to attend and pressure to attend Organisational commitment is
described as having loyalty to the organisation identifying with its core values and
influences whether or not an employee feels it is appropriate to take unauthorised
unscheduled absences Group level absenteeism is not viewed as a predictor of individual
absenteeism (Davey amp Cummings 2009320 Lambert Camp Edward amp Saylor 20058-9)
25 PREDICTORS OF ABSENTEEISM
Oi-ling (20023-6) claims that in Hong Kong there were 47500 work days lost as a result of
employee sick leave in 1998 and suggests the examining of stress levels for nurses in
different cultures to enable a fuller understanding of the predictors of absenteeism as
different cultures accept some predictors and some reject the same reasons for illness
20
Personal characteristics
2Employee value Job
expectation
1Job situation scopejob level role
stress work amp group size leadership
style
4 Satisfaction
with job situation
3 Ability to attend Illness and accidents transport problems
6 Attendance motivation
7 Employee
attendance
5 Pressure to attend work
incentiveswork ethics
Education
salary
tenure age
gender race
Occupation
Lambert et al (20058) claim that organisational commitment job satisfaction job stress
health issues and personal characteristics correlate as regards employee absenteeism The
findings of the research by Van Der Westhuizen (2006136) focused on high and low
combination of job involvement and organisational commitment and the outcome was
emphatic on the turnover as predictor of absenteeism
According to Unruh and Strickland (2007674) absenteeism from the workplace contributes
to a vicious cycle of a negative work environment which leads to more absenteeism and
increased turnover McCormick and Ilgen (198556) describe turnover as dysfunctional
where an employee wishes to leave the institution and the employer prefers to retain the
individual and is functional where the employee wishes to leave the institution and the
employer accepts the termination of services by the employee
De Wit (2006) focused on attitudes towards job factors that had an influence on
absenteeism and was not able to find a high coefficient in the test sample McGoldrick and
Arrowsmith (20018) claim that an organisation is healthier for a spread of ages Ferguson et
al (200138) state that aging employees expose organisations to high levels of absenteeism
through higher probabilities of becoming disabled for longer periods
Oi-ling (20023-6) and Patrick (200124) found that gender and age among other predictors
of absenteeism have a significant influence on absenteeism Age was positively related to
well-being in managers and negatively related to absence frequency among hospital
employees Older employees were shown to have higher responsibility at work and utilised
minimal days for sick leave Female employees were observed to have utilised more
absences than males
Andrews (1997221-222) and MINTRAC (20093-8) state that gender moderates the age
turnover relationship Women are more likely to remain in their jobs the older they get than
men do Turnover is occasionally related or preceded by high workplace absenteeism The
occupational category is linked to skill levels and salary levels The lower skill employees are
concentrated in the lower skill occupations and easily replaceable Public service employees
enjoy security of tenure which maybe a contributory cause of absence from work without
good cause a practice that is encouraged by the knowledge that they cannot be easily
dismissed from their jobs therefore have the belief it is right to stay away from work
Rogers and Hertin (1993217-222) found a correlation between the use of sick leave and
age Employees with advanced age comparatively used more sick leave in comparison with
younger employees The level of education seems to have influenced the use of sick leave
where the lower level categories of employees were found to have a higher level of
absenteeism than higher educated individuals
21
Robbins et al (200447) state that married women employees have fewer absences and
undergo fewer job turnovers Rogers and Hertin (1993222) express tenure as work
experience in years that is viewed as a predictor of employee productivity where seniority
has been found to be inversely related to absenteeism in terms of frequency and total
number of work-man days lost The level of education was found to have an influence
where the lower category of employees was found to have higher levels of absenteeism
than higher educated employees Jacobs and Roodt (2011425) and Davey and Cummings
(2009320) state that an organisational culture in hospitals can contribute towards lower
turnover as the turnover rate is a predictor of absenteeism The process can be facilitated
by promoting knowledge sharing that can provide opportunities that may meet employee
expectations
Pousette and Hanse (2002229-231) suggest that theories that make predictions about
antecedents to ill health and sickness absence make the assumption that the relationships
are the same in different occupations Reduced job autonomy is suggested to be associated
with higher sickness absence The occupation specific model is used in order to identify the
variance in the patterns in terms of occupation-groups Davey and Cummings (2009320)
found that turnover was significantly related to absenteeism
Hirschfield et al (2002553) conducted a research on low-wage public sector clerical
employees and found that those employees who perceived limited performance-reward
expectancies were likely to be absent more often The link between skilled employees and
absenteeism suggested that employees may have utilised absenteeism as a means of
compensating for perceived workplace contributions not extrinsically rewarded Unruh et al
(2007674) found that absenteeism from the workplace does contribute to a vicious cycle of
a negative work environment which leads to more absenteeism and increased turnover
26 A MULTI-GROUP INVARIANCE MODEL
A multi-group invariance structural model represents different types of occupations such as
industrial blue-collar workers industrial collar workers elderly care workers and child
health care workers The focus of this model relates to the extent to which a model that is
assumed to include a general population also includes sub-populations such as different
occupational types The occupation specific model allows different relationships between
variables in different occupations The specific model approach allows for identification of
the most common reasons for absenteeism and early retirement in the workplace and was
successfully utilised in Sweden A common model proposes that absenteeism is a
behavioural response to dissatisfaction with the job (Pousette amp Hanse 2002230-244)
Nyathi (200059) found that professional nurses were absent from work because they
wanted to prolong their weekends
22
Davey and Cummings (2009313) argue that on average health care employees are more
likely to be absent from work as a result of illness or injury than other occupations Paton
(20104) acknowledges that line managers are the fundamental building blocks for reducing
absenteeism and must be provided with the tools to manage absence The absence rate at
3 is considered very high and must be vigorously and progressively managed
FIGURE 22 MODEL SPECIFICATION
(Adapted from Pousette amp Hanse 2002232)
Pousette and Hanse (2002232-245) make the assumption that low job autonomy and low
skill discretion deprive the employees of the opportunity to handle work obstacles and
regulate workload to a manageable level implying a negative relationship to workload has
an impact on absenteeism rate Patrick (200123-24) states that changes in the working
conditions overburden the coping mechanism Work-related stress can lead to deteriorating
physical and emotional well-being The work object is the distinguishing quality between
occupations in the different occupational groups whereby the blue-collar employee works
with things that are tangible such as materials and machines whereas the white-collar
employee is knowledge based employee who is working with data
23
Structural Model
W L Work load
I H Ill-Health
S A Sickness absenteeism
S D Skills discretion
(autonomy)
27 CATASTROPHIC MODEL (CAT)
According to Buschak Craven and Ledman (199628) the catastrophic model (CAT) caters for
major illness that keeps the employee away from work for extended periods of time This
model is similar to short and long term incapacity sick leave whereby the employee has
exhausted the normal sick leave of 36 days which is catered for by DPSA section 14 (RSA
2009)
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM
The general behaviour and actions of public officials are determined by specific ethical
codes of conduct and the unethical conduct results in effective administration and
unsatisfactory service delivery (Andrews 199733) Effective control of workplace
absenteeism requires an absenteeism policy to be in place management to establish the
magnitude and patterns of absenteeism and raise awareness about the consequences of
breaking these rules (Bamford Klein amp Engelbrecht 19992)
The Determination on Leave of Absence in the Public Service (DPSA 2009 section 14 141)
the Public Service Co-ordinating Bargaining Council Resolution (PSCBC 72000) Davey and
Cummings (2009313) and DPSA (PILIR) 2009 section 3 31 state that an employee is
entitled to 36 working days sick leave with full pay in a three year cycle with the same
employer Any unused leave credits shall lapse at the end of the three year cycle The
employee is expected to utilise and manage the normal leave circumspectly The employee
who chooses to utilise sick leave days must submit a medical certificate for every occasion
of three or more sick leave days utilised The medical certificate must be issued and signed
by a practitioner or persons who are registered with the Professional Councils established
by the Act of Parliament Incapacity leave is additional sick leave granted conditionally at the
employerrsquos discretion An employee who has exhausted the normal sick leave during the
prescribed sick leave cycle and who requires to be absent from work due to a temporary
incapacity may apply for temporary incapacity leave with full pay According to the Policy
and Procedures on Incapacity Leave for Ill-Health Retirement (PILIR) (DPSA 2009) an
employer is not required to pay an employee if the employee has been absent from work
for more than two consecutive days or more than two occasions during an eight week
period and on request does not produce a medical certificate
The Public Service Regulations 2001 F (c) holds the manager accountable when an
employee abuses sick leave (RSA 2001) According to Parbhoo (20036) and Nel et al
(2008145) the doctor patient confidentiality is not above reach to the employment
relationship by suggesting that the employer can question the authenticity or contents of
the medical certificate if there is sufficient reason to do so within the confines of
confidentiality
24
According to Breetzke (20092) South African employees are challenged by global trends to
seek mechanisms to deal with excessive absenteeism at the workplace The Charted
Institute of Personnel and Development (CIPD) (200811) claims that the 2006 survey
showed that public sector employees are less likely to be disciplined or dismissed for
reasons of workplace absenteeism
281 Measuring absenteeism
Measuring absenteeism in the workplace enables the employer to determine the extent and
nature of the problem Absenteeism is measured using two measures total time lost and
absence frequency Nel et al (2001584) In institutions total time lost is determined for
every group of employees and category of absence such as sick absence authorised and
unauthorised absence The recognised international norm is 3 Institutions challenged
whether to accept the international norm as the given or strive to bring workplace
absenteeism down in the interest of quality and quantity of service delivery The total time
lost index is calculated as the Total number of days lost due to absence over the period
multiplied by a thousand and divided by the average number of employees multiplied by a
thousand and divided by an average number of employees multiplied by total work-days
over the period (Amin Das amp Goldstein 20086 Breetzke 20094 Nel et al (2001584)
According to Nel et al (2001584) high workplace absenteeism rate is suggestive of incidence
that is of short duration and therefore more disruptive to the operational plans of an
institution as prior knowledge of pending workplace absenteeism allows for forward
planning and reduction of the costs associated with absenteeism The absence frequency
rate is calculated as Number of absence incidence over the period divided by the average
number of employees employed over the period (Breetzke 20094 Nel et al 2001254)
29 IMPACT OF WORKPLACE ABSENTEEISM
Lambert et al (20056 36) claim that absenteeism has adverse effects on those employees
who are good attenders as they are shuffled around to fill in the positions of absent
employees Organisations suffer the detrimental effects and consequences of employee
absenteeism Management expend valuable time to modify employee assignments to
respond to absences When employees who are in management or in highly specialised job
assignments report sick the work assigned to them remains undone because their positions
remain vacated and the work remains for them to complete The responsibility and
accountability these employees are entrusted with may influence less use of sick leave by
them
The White Paper on Transforming Public Service Delivery (DPSA 1997) holds management
responsible for the specific level of resources and for obtaining value for money in these
resources
25
Madibana (201022) found in the research about absenteeism amongst nurses that the high
rate of absence had an impact in the reduction of quality care rendered by nurses
291 Cost to the institution
Andrews (19978221) describes an institution as the process through which activities are
grouped logically into the distinct areas and assigned to managers It results in the logical
grouping of activities in a department Workplace absenteeism influences the cost of an
institution which influences the quality of the product or service that is rendered by the
institution Employee attendance is a vital element for managing productivity of any
institution and its individual members The unfilled posts reflect the absence of public
health care employees and do not absorb budget resources for salary and upkeep of
facilities Absent personnel still receive their salaries If public servants are not on the job
the expenditures embodied in them do not reach their beneficiaries (Chaudhury amp Hammer
20032 Lambert et al 20055) The cost is direct in terms of salary expenditure or indirect in
terms of staff replacement
Ferguson et al (200138) argue that the cost of employment risk approach is about
estimation of the possible cost of any absent employee to an institution per hour per day
Robbins Odendaal and Roodt (200415) estimate that absenteeism costs South African
institutions millions of rand a year in decreased efficiency and increased benefit payments
Fakie (20053) notes that sick leave costs the national government 15 of the total basic
salary expenditure for the National Department of Health from 1 January 2001 to December
31 2003
The South African Chamber of Business (SACOB) (Patrick 200117) acknowledges that in
2006 about R19 billion were lost on account of absenteeism resulting from sick leave
According to the European Foundation (19977) United Kingdom lost 11 billion pounds in
1994 Germany lost 30 5 billion EUC in 1993 and Belgium lost 24 billion EUC in 1995
Breetzke (20092) describes indirect costs as hidden costs harder to measure and may
include economic value of lost productivity Indirect costs relate to loss of production that
may arise by engaging some expects to provide service in the field where they are closing
the staff shortage gap Rogers and Hertin (19939) and the European Foundation (19978)
view the individual employee and his or her dependants in a social dimension aspect as
exposed to reduced income as a result of extended workplace absenteeism related to ill
health where long term incapacity is involved
The total cost of employment risk approach is about estimation of the possible cost of any
absent employee to an institution per hour The cost may be direct and indirect such as
overtime low productivity and a decline in morale among workers who are expected to
cover for an absent employee (Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
26
292 Low productivity
According to Jankowitz (19911) high levels of absenteeism are disruptive to production
where operators are interdependent or where levels of service have to be maintained
Buschak Craven and Ledman (199626) argue that absenteeism generates costs for the
institution and productivity problems put an unreasonable burden on the rest of the
employees who are at work An absent employee be it physical or psychological remains an
unproductive employee Absenteeism viewed from an employerrsquos perspective is regarded as
a problem that impacts negatively on service delivery while the employeesrsquo believe their
mere presence in the workplace is being productive
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM
Managing workplace absenteeism remains a challenge for all employers and the Gauteng
Department of Health has not been spared the challenges faced by other institutions as it
provides health care services to the citizens of Gauteng The provision of good quality health
care is vital for the development of human capital The implications of declining quantity
and quality of care is grave when the human capital equity and efficiency which are the
cornerstones of health care service delivery are threatened by employees who are not at
work when expected to be (Gauteng Province 200711) Misuse of sick leave is considered to
be an overriding problem in instances where the employee does not uphold the standard of
honesty and incorruptibility or these values are not considered to be the corporate values of
the institution (Andrews 1997 221-222 MINTRAC 20093)
According to Grogan (2005237) employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
identify trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
Part V Section F(c) (RSA 2001) The workplace can be a virtual office Workplace
absenteeism is perceived to be high in unionised workplace environments where unions are
perceived to be capable of exerting control over the employer and employee relations for
the primary benefit of the employees In the public sector contractual employee benefits
are modified by collective agreements
Public service managers are to focus towards results achievement and be accountable for
the performance of their institutions (Gauteng Province 201023) Workplace absenteeism
can be reduced by tightening up policies and procedures relating to control of absenteeism
and intensifying monitoring processes on absent employees
27
According to Cloete (2004290-297) public institutions are to provide quality goods and
services The public institutions require an appropriate infrastructure to enable them to
perform their core functions (Bamford et al 19991 Buschak et al 1996 28 Munro
200722)
2101 Effective communication
According to Oi-ling (200212) managers should alter the psycho-social environment at work
and cultivate an institutional climate that supports staff and facilitate effective
communication Institutions should raise awareness to employees of their rights and
responsibilities regarding leave of absence and the consequences of abusing it (Bamford et
al 19992) The policies should be clearly written and well communicated to all employees
and be readily available and accessible In a highly unionised environment these policies are
debated in bilateral or multi-lateral forums between management or employer
representatives and labour representatives The human resource practitioners must conduct
periodic in-house training on these policies for management and employees to facilitate
uniform interpretation and enforce compliance by all stakeholders The policies must be
couched in simple understandable language that is free of legal terms for ease of
comprehension by all users The policies on workplace absenteeism must be explicit of
actions to be taken when policies have been violated or employees are aggrieved
2102 Empowerment of managers
Workplace absenteeism is multi-dimensional requiring inputs from all related fields
Managers require on-going support and training on issues that relate to absenteeism at the
workplace The human resource unit works with managers to establish performance
standards training of employees on the importance of execution and assists managers to
focus on continuous improvements superior execution and employee empowerment
(Bergdahl 20019 RSA 2011)
The labour relations unit supports the training of managers on grievance handling bilateral
and multi-lateral encounters with employee representatives with employee education
issues specific to workplace absenteeism The Charted Institute of Personnel and
Development (CIPD) (200835) reported that 70 of managers in the public service have
been trained in workplace absenteeism handling
Employment relationships bind human resource and industrial relations together with the
common objective of achieving institutional goals and labour peace Managers focus on
managing the institution for productivity at the lowest possible cost by providing quality
care therefore reducing the risk of litigation control of absence from work and work
efficiency
28
It is the delays in dealing with issues that give the employees the feeling of being unfairly
treated and demoralised Consistency in upholding these processes is essential for creation
of a stable employment relationship while any deviation from the set processes give rise to
worker unfriendly environment (Bergdahl 20118-9)
2103 Monitoring of workplace absenteeism
The manager is expected to keep accurate records for all leave of absence taken by
employees In terms of the management of ill-health absencersquos the manager has to ensure
that the eight week rule is observed whereby the employee who has been absent from
work on more than two occasions during an eight- week period must regardless of the
duration of the sickness or injury submit a medical certificate (RSA Part V section F (b)
DPSA 2009 section 14 148) Pierce (200921) believes that management of human capital
may be achieved through the integration of employee benefits employee assistance
programmes and human capital
Monitoring of absenteeism is a human resource function that gets lost in the competing
functions that are carried out by human resource practitioners High levels of absenteeism
are an indication of poor management and or conflict within the employment relationship
The methods to monitor workplace absenteeism vary from one institution to the other It is
human resource management that establishes common guidelines that are used by
management to monitor workplace absenteeism In monitoring absenteeism the manager
considers each employeersquos case on its merit
The manager focuses on certain aspects of the case such as failure to call in on the day of
absence pattern of use of sick leave before or after holidays and sick absence occurring on
certain days of the week or month Monitoring systems to monitor and record attendance
of work are put in place to assist management with simple accurate functional data that
facilitates informed decision- taking at management level The employees of the province
and their attendance at work become the focal point of the province in relation to service
delivery Peer pressure monitoring comes from colleagues at the same facility Hierarchical
monitoring of employees by management may lead to more attendance for fear of being
discovered (Chaudhury amp Hammer 200319 Gauteng Province 201015) A health care
service institution may use Health Information System and Personnel and Salary
Administration System (PERSAL) among others to ease the burden of the monitoring
process All these tools combined are useful in gathering administrative data for
management
29
2104 Visits to facilities
The role of human resource at institutional level is to support and guide management as
well as monitor compliance issues Workplace absenteeism remains a key focus area
because of its impact on the budget of an organisation Unscheduled facility visits are
conducted with the view to audit workplace absenteeism The audit is to be done in line
with the auditor-general or internal risk managementrsquos approach to encourage consistency
A check list that is used is prepared by human resource practitioners and institutions are
familiar with A human resource accounting officer of the institution should be involved
when an audit is done
The institution must have evidence available of sporadic visits to employees who have been
identified as having developed absenteeism patterns with the view to rule out elective
absence The European Foundation (199713) and Munro (200722) state that ill- health is
the main reason for workplace absenteeism Employees who present with ill- health are
generally and frequently more absent from work than the healthy ones The authors also
observe that not all employee assistance programmes aimed at reducing workplace
absenteeism have an effect on the ill-health of the employees which render the
unscheduled visit to the employees vital to see where the caring employer could be of
assistance
2105 Incentive system
According to Buschak et al (199628) the catastrophic model (CAT) caters for major illness
that keeps the employee away from work for extended periods of time This model is similar
to short and long term incapacity sick leave which is catered for by PILIR subsection 73
(DPSA 2009) The managers require special training for successful implementation of the
policy The paid time off model (PTO) has hidden benefits incentives for employees not to
use unnecessary sick days which are then paid for at retirement The research by Lambert
and Camp (20054) compares the Civil Service Retirement System (CSRS) and the Federal
Employees Retirement System (FERS) and showed that in the final analysis and when
novelty wore off workplace absenteeism was not necessarily reduced by the incentive
system
Management should use the strategy to raise awareness about responsible utilisation of sick
leave through workshops about PILIR and the eight week rule It should show the benefits
of good sick leave management when employees are challenged with temporary or
permanent incapacity leave
The use it or lose it approach of the current system reward the abuse of sick leave as it is
viewed as not being beneficial by the employees to act responsible towards the use of sick
leave There is no deterrent not to abuse sick leave in the public sector
30
2106 Team support
Institutions value team effort over individual achievement Operational competencies are
viewed as essential Managers encourage effective communication among team members
motivating others and the development of problem-solving skills Managers through the
team development effort encourage nurturing and transmitting of the institutional culture
Institutional culture refers to a system of shared meaning within an organisation that
determines how employees behave in the workplace Culture and people are like glue that
ensures that institutional standards are upheld Individuals become units that form the
team and conversations at work are encouraged to strengthen team work knowledge
transfer and productivity (Bergdahl 20018-10 Goldsmith amp Morgan 200378 Robbins amp
Decenzo 2001174)
2107 Return-to-work interviews
According to Paton (20101ndash5) a phased return-to-work data management and remote
services are among the approaches employers may use to manage workplace absenteeism
The intervention can involve use of Information Technology systems and telephone
discussions Good absence management is about good people management The return-to-
work interviews provide management with the opportunity to get to know the employee
better and for the employee to substantiate his or her case The employee is afforded
privacy during the sessions which should happen as soon as the employee comes back to
work The key success in this strategy is unthreatening follow ups that are done A multi-
faceted approach is used to get people back to work such as phoning maintaining regular
contact and taking medical advice
The Charted Institute of Personnel Development Annual Report (200835) reported 90 of
public services that use the strategy and 77 use the risk assessment to aid return- to-
work The manager should have private counselling sessions with the employee as soon as
the employee returns to work These sessions provide the employee with the opportunity to
put his or her case across and for the employer to get a first-hand opportunity to asses if the
employee is fit enough to come back to work The employer has to make the employee
aware of the status of the meeting that it is formal and proceedings are recorded The
employer is to keep accurate records of all counselling sessions
31
2108 Employee assistance programme (EAP)
DPSA (PILIR2009) prescribes that the PILIR committee promotes EAP in the workplace and
each institution to establish a committee The PILIR committee consists of a labour relations
officer an EAP practitioner a health practitioner an employee wellness practitioner and
any other relevant practitioner who is co-opted on a needs basis The purpose of the
committee is to manage short and long term incapacity which is sick leave utilised after the
employee has exhausted the 36 days normal sick leave in a three year cycle The short term
incapacity sick leave is of longer than three days and less than 29 days and long term
incapacity is sick leave longer than 29 days The short spells of sick leave become a concern
when there is evidence of a pattern of abuse It is a call for the manager to intervene Every
organisation should provide EAP that is funded by the employer to the employees A health
risk manager is used by the employees who are expected to honour referrals and stay with
the programme until such time that there is evidence of recovery failure by the employee
to accept the programme should attract a disciplinary process
According to Mellor Arnold and Gelade (20098) the amount of support that followers
receive from their transformational leader or co-worker may help reduce levels of absence
by making the workplace a more pleasant place to be and perhaps by helping the person
find solutions to work out family conflict or other problems that produce absence Landstad
et al (20011) suggest that the individuals in the preventive intervention group who were
less than 42 years of age total absence due to sickness decreased The change was obvious
to the cleaners who had a previous history of high absence due to sickness The Charted
Institute of Personnel Development (200836) focused on working-man days lost
management of absenteeism employee well-being and employee rehabilitation The skilled
employees were reported as 12 who were using rehabilitation programmes Yende
(200535) and Fakie (200517) state that EAP despite having been around since 1996 for the
National Department of Health has not actually been managed and utilised to its full extent
whereby if fully utilised would assist in the management of employee workplace
absenteeism
2109 Occupational and safety committee
The focus of this committee is on the provision of a safe working environment by the
employer (RSA Part VI section D 2001) It monitors issues of compliance and adopts the
employee advocacy role The committee consists of all the major stakeholders such as
employee representatives labour representatives that represent employees in the
institution on issues of safety at the workplace In the context of the Gauteng Department
of Health the committee engages with the labour representatives and employer
representatives at bilateral and provincial multi-lateral scheduled meetings
32
According to Du Toit and Van Der Waldt (1998139) the International Labour Organisation
recommends creation and maintaining of a pleasant work environment in order to improve
productivity The environment must stimulate the employee to ensure efficiency and
effectiveness
21010 Review committee
This structure is essential when dealing with incapacity leave It is composed of
management human resource practitioner employee representative labour relations
officer employee wellness and any adhoc person needed in terms of the case under
discussion (DPSA PILIR 2009) The employee reserves the right to lodge a grievance about
the outcome of his incapacity request if it is negative The role of the committee is to
provide a transparent forum reduce hostility against management and to protect the rights
of the employee through involvement of the employee representative
211 CONCLUSION
The literature review that has been consulted explores the workplace absenteeism and its
impact on the institution The employment relationships represent a triangle that consists of
the employer the employee and the industrial environment The relationship is multi-
dimensional and highly regulated with built in mechanisms to handle conflict in the
workplace Conflict is inherent to the employment relationship and structures and
mechanisms such as bargaining councils the Commission for Conciliation Mediation and
Arbitration and Labour Courts are structures for recourse The theory of absenteeism and
employment relationship were explored Management intervention strategies were
explained Controlling absenteeism in the workplace begins with a sound absenteeism
policy that is incorporated into an employee induction programme Communicating and
educating the employees about the absenteeism policy takes the centre stage in the
employment relationship Vigilant monitoring of workplace absenteeism is the responsibility
of the manager closest to the employee such as the supervisor Workplace attendance
problems of employees can be handled using sound judgement keeping accurate
attendance records and administering the policy fairly and consistently
Chapter 3 will collect data which will confirm or negate the literature review that has been
explored in chapter 2
33
CHAPTER 3
METHODOLOGY OF THE RESEARCH
31 INTRODUCTION
Chapter 3 focuses on the methodology used to determine the absenteeism in the four
hospitals of the Gauteng Department of Health The research design and the methodology
that have been used to collect data are discussed below The data are collected in terms of
the characteristics of the stratified random sample such as absenteeism of the different
occupational categories gender age tenure of service race groups and salary
32 RESEARCH DESIGN
A research design is the overall plan for relating the conceptual problem to relevant
empirical research It is a quantitative descriptive research that involves the systematic
collection of numerical information under conditions of considerable control The choice of
the research design influences subsequent research activities such as identifying the target
subjects what data to collect and how they should be collected The research design is a
descriptive survey which is concerned with characteristics of a specific population subject at
a fixed point in time for comparative purposes The focus is on a representative sample of
the relevant population It is concerned with the accuracy of the findings and their
generalisability The survey is used to understand the behaviour of employees with regards
to motivation satisfaction and grievances (Babbie 1992 89 Ghauri et al 199527 60 Brink
199611 Welman et al 200152)
321 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services The four hospitals that have been targeted for the study of absenteeism are Tara
Moross Centre Hospital in Region A under the Johannesburg Metropolitan Municipality
Germiston Regional Hospital which is in Region B under Ekurhuleni Metropolitan
Municipality ODI District Hospital in Region C under Tshwane Metropolitan Municipality
and George Mukhari Academic Hospital in Region C under Tshwane Metropolitan
Municipality Each hospital is unique in its character in terms of specialisation of health care
delivery service The sample is a stratified random sampling which is composed of various
clearly recognisable non-overlapping sub-populations (strata) that differ from one another
in terms of variables that are a combination of more than one variable such as age sex
income level or educational level The purpose is to ensure that every part of the population
(every stratum) is represented The members of a particular stratum are homogeneous with
the population at large
34
The sample is representative of a population with clearly distinguishable strata with a
greater degree of certainty (Babbie 19927 Brink 1996138 Brynard amp Hanekom 2005 44
Ghauri et al 199578 Welman amp Kruger 200155-56 Polit amp Hungler 199518)
The data were collected in three phases The first phase of data collection was done through
auditing of hard copies of identified personnel files encomprising ten files per hospital and
using the tools in annexure A and B The forty employeesrsquo profiles were accessed through
the Human Resource Information System (HRIM) located in the Gauteng Department of
Health Head Office The respective employeesrsquo profiles were handed over to the human
resource manager in the respective hospital on the morning of the audit for the human
resource practitioner to draw out the hard copy files for auditing The characteristics of the
individuals that were identified for the first phase were males and females as well as
representatives from the different race groups The auditing of the files were for the
complete working life of the employees and not only confined to 2008 calendar year
Registers that are used by human resource administration to control the movement of the
leave form were inspected as evidence of the control system in place The purpose of
auditing the files was to gain insight into how leave in general was captured managed and
controlled by the hospitals
The second phase of data collection were done through structured interviews with four
human resource managers who were directly accountable for management and control of
leave of absence in general in the four hospitals A structured interview provides for a more
organised approach and a more stable basis for assessment of the different candidates
(Erasmus et al 2005250) The structured interview was conducted using the tool in
annexure C Tara Moross Centre Hospital had been functioning without a human resource
manager and the manager that was interviewed had been in the post for three months The
human resource practitioner who was at salary level 8 and acting in the Assistant Directorrsquos
post (manager level 9) was invited to join the manager and be part of the structured
interview ODI District Hospital had three human resource practitioners including the
accounting officer at level 8 in an acting capacity The third phase of data collection was
through the Human Resource Information Management System (HRIM) This system uses
the Personnel Remuneration Administration System (PERSAL) to collect data Data in this
system is categorised in characteristics such as salary level date of appointment
occupational category gender age in units of five race employing hospital employment
status in different sub-categories such as session contract and full-time and the different
types of leave of absence The continuous sick leave of four to five days was excluded from
processing and focus was laid on sporadic days to the start and end of a weekend
35
The research used secondary data in analysing sick leave utilised by full time employees in
the identified hospitals for the period of 1 January to 31 December of 2008 using Persal The
total population sample was four thousand and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range from level 1 to
12 The research used past events such as sick leave utilised by employees using secondary
data from Persal falling into the category of historical empirical study The interval scale of
measurement was used in the quantitative research and actual numbers are ordered with
equal measurement between each category (Brink 1996 149 Brynard amp Hanekom 200528-
29 Mouton 200552100170)
33 UNIT OF ANALYSIS
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the study refers to observation of work attendance by the
employees of Gauteng Department of Health in the four hospitals The observation deals
with the historical events as employees have already utilised the sick leave in the workplace
The subjects that are studied are the core health care providers such as doctors nurses and
support employees such as allied administration and administration support (Mouton 2005
51-52 Welman et al 2001 52-53)
34 UNIT OF OBSERVATIONS
The observations that are made are of health care employees and support teams in Tara
Moross Centre Hospital Germiston Hospital ODI Hospital and George Mukhari Hospital
and describe the characteristics of a large number of individual people such as sex age
salary range occupational category tenure of service and race in relation to absenteeism in
the workplace The descriptive study and the individual characteristics are aggregated for
the purpose of describing a larger group (Babbie 199292)
35 CONSTRUCT VALIDITY
Construct validity is concerned with the question What construct is the instrument actually
measuring (Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with four of the accounting officers in the leave managements The third phase was
collecting of personnel data through the Persal system
36
36 ETHICAL CONSIDERATIONS
Ethical considerations will include amongst other issues such as the protection of the units
of analysis and units of observations from discomfort and harm by not revealing
information which can cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity
Anonymity is achieved when the researcher cannot link a given response with a given
respondent and reporting aggregate data only When data are collected at one sitting and
not over a period of time makes it possible to achieve anonymity as the need for follow up is
eliminated Subjects of observations are selected for reasons directly related to the problem
being studied as the principle of justice Confidentiality is about the researcherrsquos
responsibility to protect all data gathered within the scope of the study and shared only
with people involved in the research (Babbie 1992465ndash466 Brink 199640ndash41 45 Polit amp
Hungler 1995 31-36)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous to the researcher The interview was part
of the actual audit that was done as part of monitoring and evaluation that was in progress
in the Department of Health following a negative auditor generalrsquos report about
management of leave in general The managers were put at ease as they were given the
checklist afterwards for self-monitoring and for future self-auditing
The data that were collected through Persal identified employees through the Persal
number and kept their identities anonymous The data that were collected through the hard
copy of employeesrsquo files were used to point out areas of concern to the managers and the
files did not leave the office of the manager at the end of the process once more protecting
the identity of the employee
37 CONCLUSION
This chapter dealt with the research design which is the overall plan for relating the
conceptual problem to relevant empirical research The methodology used a stratified
random sample which is composed of various clearly recognisable non-overlapping sub-
populations that differ from one another in terms of variables that are a combination of
more than one variable The data collection was done through three phases The unit of
analysis refers to the persons who are studied The unit of observations are health care
workers and support teams in the four identified hospitals The construct validity used a
multi-trait multi-method approach Ethical considerations include among other issues
protection of the unit of analysis and the unit of observations from discomfort and harm
Chapter 4 discusses the analysis and interpretation of the data gathered in chapter 3
37
CHAPTER 4
INTERPRETATION AND ANALYSIS OF DATA
41 INTRODUCTION
This chapter focuses on the research analysis and interpretation of data gathered on
workplace absenteeism in the Department of Health of the Gauteng Province It seeks to
identify differences or similarities in the leave trends in the 2008 calendar year between the
four identified hospitals chosen for the study in the Municipality of Tshwane Ekurhuleni and
Johannesburg The year 2008 was chosen as a second year in the leave cycle that started in
2007 The type of leave of absence is interpreted as a collective that does not specify the
type of sickness or illness or it being acute or chronic Workplace absenteeism is absence of
the employee at the workplace that is defined by Du Toit and Van Der Waldt (1998139) as
the place that the institution makes available and where officials have to perform their
work It forms part of the internal environment for public administration in the public
service Direct public administration is directly concerned with the rendering of services to
the citizens of the country
Chapter 4 discusses the study of workplace absenteeism in the four identified institutions
namely Tara Moross Centre Hospital Germiston Hospital ODI District Hospital and George
Mukhari Hospital In this research the following factors will be examined the organisational
structure and absenteeism of the different workforce categories such as medical and
nursing professionals administrative staff allied professionals and various categories of the
general assistants workforce and their relation to absenteeism in the institution
42 THE STRUCTURE OF THE ORGANISATION
The Gauteng Province is one of the nine provinces of South Africa In 2005 the auditor-
general conducted an audit of sick leave performance in six national departments and the
Gauteng Province was among those that were omitted from the audit The research focuses
on the Gauteng Department of Health (GDoH) whose core function is to provide health care
services to the people of Gauteng The provision of health care services is labour intensive
and requires large numbers of personnel for effective service delivery The GDoH is serviced
by thirty-four hospitals four of which have been identified for the study of management of
sick leave The employee attendance to work is essential to the achievements of the
Departmental goals The Determination on Leave of Absence determines the leave policy for
public service employees (DPSA 2009) The employees of GDoH represent the staff
component as reflected in the organisational structure of the department
38
The Gauteng Department of Health (GDoH) provides the basic health services to the people
of Gauteng who as internal or out-patients are clients or consumers of the services referred
to as line functions Public administration services rely heavily on support services such as
the personnel department that renders support to line functions that provide the actual
service of patient care Support services are considered as indirect public administration
services and essential in efficient public service delivery Workplace absenteeism has a
negative impact on productivity Employees of the Gauteng Department of Health and their
attendance to work are the focal point of the Province in terms of effective health care
service delivery that is customer focused
Political ideologies as those espoused by labour representatives are part of the external
factors in the workplace environment that consequently have an impact on public
administration and management and workplace attendance by employees (Du Toit amp Van
Der Waldt 1998139170)
FIGURE 41 INTERGRATED ORGANISATIONAL STRUCTURE
(Adapted from Gauteng Department of Health organisational structure 2010)
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY
The Gauteng Provincial Government has made a commitment to its people to account for
the delivery of services as its electoral mandate This commitment will be achieved only
when monitoring and evaluation of its performance is enforced by all Gauteng Department
of Health service providers
39
MEC
HOD
COP
Senior Exec
CD HAST CD Health program
Senior Exc
CD Tshwane
CD JHBWest
CFO
Manage Account
SENIOR CORPORATE
HRM amp LR
GenderampDisability
The Gauteng Governmentrsquos commitment to provision of health care services to all its
citizens is demonstrated by the decentralisation of management of service delivery with the
view to foster accountability increase efficiency and accountability (ANC 199419ndash20
Goldstein 200815) The interpretation of the analysed data takes the sector performance
approach into consideration when the interpretation of absence is across all the
occupational groups for the 2008 calendar year (Gauteng Province 201015)
44 COMPARISON OF HOSPITALSPERMANENT EMPLOYEES
Gauteng employees are counted at 51475 from the Personnel Salary Administration System
(PERSAL) as of March 2008 The population from the four chosen hospitals has been
counted at 4010 reflecting 8 of the total population The different groups of employees
were identified as Africans represented as n=3902 Whites as n=51 Indians as n=14 and
Coloureds as n=43
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALS
(Source Compiled by the researcher C S Ndhlovu 2012)
Figure 42 reflects the racial split percentage of the workforce (n=4010) of the hospitals
The population from the four hospitals has been counted as 4010 reflecting 8 (n=51475)
of the total working population for Gauteng Department of Health as from 1 January to 31
December 2008 The different groups of employees were identified as Africans represented
by 973 (n=3902) Whites as 13 (n=51) Indians as 03 (n=14) and Coloureds as 11
(n=43) The George Mukhari Hospital has a female dominated workforce at 739 (n= 2097)
in a total workforce of n=2836
40
Population n=4010
Africans 973
Whites 13
Coloureds 11
Indians 03
TABLE 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALS
RACE TARA HOSPITAL GERMISTON GEORGE
MUKHARI
ODI TOTAL
Africans 227 367 2836 472 3902
Whites 23 24 3 1 51
Coloureds 5 37 0 1 43
Indians 13 1 0 0 14
Population 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 1 focuses on the distribution of race and the population of the total workforce The
geographical area of the hospital determines the demographics and the tendency of some
groups being poorly represented or totally absent The research focused on permanent
employees of the four hospitals The George Mukhari Hospital employees are reflected as
7079 (n=2839) ODI Hospital as 1182 (n=474) Germiston Hospital as 1069 (n=429)
and Tara Moross Centre Hospital as 668 (n=268) of the total working population Tara
Moross Centre and Germiston Hospitals are located in cosmopolitan areas while the George
Mukhari and the ODI Hospitals are in rural and semirural areas The positioning of the latter
hospitals may account for the high African workforce
41
TABLE 2 COMPARISONS OF NUMBERS OF ADMINISTRATION AND SUPPORT STAFF IN THE
DIFFERENT HOSPITALS
OCCUPATIONAL
GROUP
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Administration
staff
48 60 297 61 466
Administration
support
103 140 719 133 1095
TOTAL 151 200 1016 194 1561
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 2 presents the administration employees and the administration support in the four
hospitals Tara Moross Centre Hospital is represented by 3179 (n=151) of administration
and 6822 (n=103) administration support The George Mukhari Hospital has the highest
representation by the administration support at 7077 (n=1016) The high representation
of the administration support staff at George Mukhari Hospital could be partly because of
the semi-rural environment A semi-rural environment is usually characterised by poverty
which may have a negative influence on opportunities to access education and skills
Doctors and nurses are highly marketable because of the educational levels and skills that
are lucrative and enable this group to be highly mobile geographically (Chaudhury amp
Hammer 20033)
42
TABLE 3 GENDER COMPARISON IN DIFFERENT HOSPITALS
GROUPS HOSPITALS MALE FEMALE POPULATION
Africans Tara 83 144 227
Germiston 52 315 367
George Mukhari 739 2097 2836
ODI 109 363 472
TOTAL 983 2919 3902
Whites Tara 5 18 23
Germiston 5 19 24
George Mukhari 3 0 3
ODI 1 0 1
TOTAL 14 37 51
Indians Tara 1 12 13
Germiston 0 1 1
George Mukhari 0 0 0
ODI 0 0 0
TOTAL 1 13 14
Coloureds Tara 1 4 5
Germiston 6 31 37
George Mukhari 0 0 0
ODI 1 0 1
TOTAL
GRAND TOTAL
8
1006
35
3004
43
4010
(Source Compiled by C S Ndhlovu 2012)
Table 3 focuses on gender distribution in the population of the research represented by
males and females in the different racial groups
43
The geographical area of the hospital determines the demographics and the tendency of
some groups being poorly represented or totally absent The males of the different hospitals
account for 251 (n=1006) while the females account for 749 (n=3004)
The George Mukhari Hospital has a female dominated workforce at 7394 (n=2097) out of
a total workforce of n=2836 White male employees are represented by 011 (n=3) against
the total workforce of the hospital (n=2839) There are no Indians and nor any Coloured
employees African males are represented by 2603 (n=739) The same hospital has no
white female employees no Indians no Coloureds and 7395 (n=2097) African females
The table reflects a predominantly African female workforce The hospital is situated in a
rural setting and this may have an impact on the vast difference in the gender
representation
The Tara Moross Centre and Germiston Hospitals are located in cosmopolitan areas They
have 187 (n=5) and 1117 (n=5) White male employees respectively and 672 (n=18)
and 443 (n=19) female employees respectively Tara Moross Centre Hospital has 4 48
(n=12) female Indian employees while Germiston Hospital has only 024 (n=1) Germiston
Hospital has 723 (n=31) female Coloured employees while Tara Moross Centre has 150
(n=4) The core function of the various hospitals may have influenced the gender
distribution
TABLE 4 COMPARISON OF TENURE OF SERVICE IN RELATION TO ABSENTEEISM IN THE
FOUR HOSPITALS
TENURE IN YEARS DAYS OF ABSENCE PERCENTAGE
1ndash10 4451 30
11ndash20 6577 443
21ndash30 2934 198
31ndash40 878 59
TOTAL 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 4 reflects the level of tenure of the total workforce from 1 year to 40 years of service
Tenure of 11 years to 20 years of service reflects 443 (n=6577) utilisation of leave of
absence and remains the highest rate of absenteeism followed by tenure of 1 to 10 years of
service at a 30 absenteeism rate
44
TABLE 5 COMPARISON OF THE OCCUPATIONAL GROUPS IN THE DIFFERENT HOSPITALS
OCCUPATIONAL
CATEGORIES
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Doctors 12 12 354 19 397
Professional
nurse
47 81 548 109 785
Staff nurse 15 53 358 56 482
Nurse assistant 16 50 308 55 429
Social worker 4 4 8 3 19
Occupational
therapists
4 0 15 1 20
Radiographer 0 3 27 6 36
Clinical
Psychologists
4 0 10 2 16
Physiotherapists 0 1 9 1 11
Dieticians 0 0 5 3 8
Finance 4 11 59 9 83
Speech
therapists
0 0 5 1 6
Pharmacists 2 9 36 5 52
Dentists 0 0 0 3 3
Technicians 2 5 51 6 64
Librarian 1 0 0 0 1
Security 6 0 30 1 37
Administration
and support
151 200 1016 194 1561
TOTAL 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 5 reflects a great difference in terms of number of occupational groups in the four
hospitals
45
The core function and the size of the hospital seems to have a bearing on how many
occupational categories of employees are to be found in that hospital as well as the actual
figures of these categories The George Mukhari Hospital is an academic hospital that trains
medical doctors This hospital has 1247 (n=354) doctors in a staff establishment of
n=2839 Tara Moross Centre has 448 (n=12) in a staff establishment of n=268 Germiston
has 280 (n=12) in a staff establishment of n=429 and ODI District hospital has 401
(n=19) in a staff establishment of n=474 This trend of vast differences in figures
represented by the occupational groups is evident in the category of professional nurses
where George Mukhari Hospital reflects 1931 (n= 548) nurses Tara Moross Centre is
represented by 1754 (n=47) Germiston by 1889 (n=81) and ODI District hospital by
23 (n=109) The impact of absenteeism is pronounced when viewed against the level of
facility capacity in terms of human resources of the core occupational groups
441 The Tara Moross Centre Hospital
Tara Moross Centre Hospital is a speciality psychiatric hospital in Region A with a workforce
of 669 (n=268) of the total workforce (n=4010) The core function of the hospital is
specialised such that some occupational categories are not available in the hospital as part
of the workforce and patients are referred out to other facilities for specialised treatment
Tara Moross Centre Hospital falls under the jurisdiction of the Johannesburg Metropolitan
Municipality
442 The Germiston Hospital
Germiston Hospital is a regional general hospital in Region B with a total permanent staff
establishment of 1070 (n= 429) of the total workforce (n=4010) The hospital falls under
the Ekurhuleni Metropolitan Municipality It does not have occupational therapists clinical
psychologists dieticians speech therapists and dentists in its permanent staff
443 The ODI District Hospital
The ODI District Hospital is in Region C and is in transition due to boundary changes It is
being transferred from the North West Province to the Gauteng Province The hospital is in
a semi-rural area with a staff component of 118 (n=474) of full-time employees (n=4010)
and falls under Tshwane Metropolitan Municipality It is a general district hospital
444 The George Mukhari Hospital
The George Mukhari Hospital is an academic hospital in Region C under Tshwane
Metropolitan Municipality The hospital trains doctors and employs 010 (n=3) White male
employees 26 (n=739) African males and7184 (n=2097) African females out of the
total female workforce (n=2919)
46
This phenomenon may be as a result of the hospital having the highest general assistants
workforce at 2065 (n=586) out of the workforce (n=2839) The George Mukhari Hospital
has the highest number of general assistants out of the four hospitals represented as 25
(n=719) in a total workforce of n=2836 African employees
45 RESEARCH INTERPRETATION
The interpretation of leave of absence is confined to salary level 1 to 12 full time employees
of the Gauteng Department of Health who took leave of absence from the workplace for the
calendar year in 2008 It excludes the contract employees periodic remuneration foreign
employees and permanent employees above salary range 13
The Basic Conditions of Employment Act 75 of 1997 Section 9 (3) (RSA 1997) prescribes
procedures in terms of progressive reduction of the maximum working hours to the goal of
a 40-hour working week and an eight-hour working day Finnemore and Van Rensburg
(2002462) state that the reduction of maximum working hours to 40 hours a week is done
through collective bargaining with due regard to job creation efficiency and health safety
and welfare of employees Du Toit and Van Der Waldt (1998232) use the formula to
aggregate lost working-man hours due to ill health and disability as aggregate lost hours in
the survey period divided by 40 hours in a week and x number of hours in a year A formula
to work out the absenteeism rate by Pierce (2009) is represented as A=BC A= Absenteeism
rate B= Total number of days lost due to absenteeism in a given period C= Total number of
working- man days available in the given period C=D x E D=Total number of employees
planned to work in the given period E=Number of available working days in the given
period
The approach of the research uses the principle of absence from the workplace when due to
work to identify the lost working hours (Pierce 2009 Davey amp Cummings 2009313) The
study applies a retrospective approach
The working-man lost days for the Province in the four hospitals is approached in terms of
lost working -man days simplified refers to the number of days meant to have been worked
but actually not worked due to illness or disability by the employees in a year divided by the
total number of employees of the public sector (PXVI) Barker (200779) argues that a
reduction in working hours increases the hourly cost of production and unit production
unless there is a commensurate increase in productivity This approach has a similar effect
on workplace absenteeism when the workload of those employees who are present
increases as they carry the double load to meet the demands of service delivery The cost of
absence to the Province is expressed as salary expenditure for each day of leave of absence
from the workplace (PSC 2002 xiii Pierce 2009)
47
The salary range is laid down according to Annexure in DPSA Circular 1 of 2008 The Gauteng
Government experienced a cost estimated at R29 million in 2000 and approximately R54
million in 2001 from absenteeism and loss of working time (Parbhoo20031)
The formula that is used in this research to calculate lost man work-hours is collective
working days of absence multiplied by 8 hours in a working day resulting in the total
working hours that are lost This formula can be represented as
Lost days x hours (8) in a working day = lost working hours
As stipulated by the Basic Conditions of Employment Act 75 of 1997 section 9 1(c) 3
TABLE 6 RACES IN RELATION TO ABSENTEEISM
RACE TOTAL DAYS OF ABSENTEEISM PERCENTAGE
Africans 14295 963
Whites 242 16
Coloureds 201 14
Indians 102 07
TOTALS 14840 100
(Source Compiled by the researcher 2012)
Table 6 represents absenteeism in the diverse races in the workplace The absenteeism rate
seems to be proportional to the number of employees The Employment Equity Act 55 of
1998 defines the term ldquoblackrdquo as a generic term which means Africans Coloureds and
Indians The Africans as a race group is represented by 963 (n=14295) of the total
working days lost (n=14840) The high figure of lost working-man days reflects the
demographics of the four hospitals The George Mukhari Hospital is in a rural setting that is
predominantly African populated and employs the highest number of Africans as
represented in table 3 Whites are presented by 16 and not represented in all
occupational categories and salary ranges that could explain the low figures and
percentages associated with working-man days lost Africans constitute the highest number
of employees as well as the highest percentage of working-man days lost Absenteeism
percentage is proportional to the employment figures for this race group The Indian race
group is represented by the lowest figure of employment and lowest percentage of leave of
absence which is proportional to the employment figure
48
TABLE 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM
OCCUPATIONAL
GROUPS
TARA GERMISTON ODI GEORGE
MUKHARI
TOTALS
DOCTORS 22 118 5 290 435
PROFESSIONAL NURSE 272 346 20 2459 3097
STAFF NURSE 128 247 13 1568 1956
NURSE-ASSISTANT 150 126 25 1145 1446
FINANCE 0 0 0 386 386
ADMINISTRATION 57 272 20 1923 2272
ADMIN SUPPORT 754 547 163 3784 5248
TOTAL 1383 1656 246 11555 14840
(Source Compiled by C S Ndhlovu 2012)
Table 7 reflects the working-man days lost by the different occupational groups The
doctorsrsquo workload in terms of the annual report for Gauteng Department of Health
(2008951) was 226 as against the target of 227 while the national target was 187
The bed occupancy rate target for the same time was 75 while the actual figure was
653 The annual report interpreted in conjunction with the data of leave of absence for
doctors reflects a negative impact in terms of service delivery and the cost factor to the
department
451 Occupational groups in relation to absenteeism
The multi-group invariance structural model presents different types of occupations and is
used to identify variance in the patterns in terms of occupational groups The model allows
different relationships between variables in different occupations The different
occupational groups are doctors professional nurses and sub-categories administration
staff and administration support staff (Pousette amp Hanse 2002230) According to Gaudine
and Gregory (2010599) absenteeism was a problem among health care workers in
comparison to other employees in other sectors The cornerstone of an efficient health care
service delivery is equity and efficiency which is threatened when employees are not at
work when expected to be (Andrews 199734-35 DPSA 1997)
49
According to the Charted Institute of Personnel Development (200811) the survey that was
conducted found that public sector employees are less likely to be disciplined or dismissed
for reasons of workplace absenteeism
Tables 5 and 6 and 7 reflect the different occupational groups and the level of absenteeism
in the four hospitals of the Gauteng Department of Health
4511 Doctors
Doctors are represented by 10 (n=397) of the total working population (n=4010) The
29 (n=435) indicates the number of working-man days lost in relation to the total
working- man days lost (n=14840) The percentage of working- man days lost in relation to
the total number of full time employees of the four hospitals is reflected as 435 divided by
n=4010 times the percentage which results in 108 (n=435) working-man days lost
multiplied by 8 hours that represent a working day The outcome is n=3480 working-man
hours The cost to the Province is calculated in terms of the salary expenditure as direct and
indirect salary payment for lost working-man hours estimated at 3480 hours at salary level
10 at R217 482 to salary level 12 at R 407745 as well as indirect costs such as replacement
of staff and overtime
The doctorsrsquo workload in terms of Gauteng Province 20089 annual report (2008951)
reflects the doctorrsquos workload as 226 as against the target of 227 while the national
target is reflected as 187 The bed occupancy rate target for the same time is 75 while
the actual target rate is 653 The annual report when interpreted in conjunction with the
data of leave of absence for doctors reflects a negative impact in terms of service delivery
and the cost factor to the Department when considering a loss of n=3480 man hours of
work
Chaudhury and Hammer (200311) found in their research that the doctors presented the
highest absenteeism rate Serneels et al (2008210) argue that absenteeism is rife in the
public sector where employees hold two jobs and is highest among doctors The doctor
absenteeism rate in the research does not stand out as high in comparison with the other
occupational groups The doctor absenteeism rate is 29 when compared to the total
workforce This occupational group is represented by 10 of the total population The
doctorsrsquo absenteeism rate does not seem to be outstandingly high in comparison with the
other occupational groups in relation to the total number of permanent doctors
50
4512 Professional nurses
The professional nursesrsquo absenteeism is reflected as 208 (n=3088) that indicates the
number of working-man days lost in relation to the total working-man days lost (n=14840)
The percentage of working-man days lost in relation to the total number of full time
employees (n=4010) in the four hospitals is reflected as 77 The cost to the Province
translates into direct and indirect salary expenditure which is spread from salary level 4 to
12 at R64 410 to R407 745 in 2008 for the total duration of lost working days
Du Toit and Van Der Waldt (1998232) pointed out a crisis in four other public hospitals in
the Gauteng Province that was caused by budget cuts and shortage of doctors and nurses in
2008 The vacancy rate of 697 in the professional nurse category and the absence rate of
208 in 2008 in the four hospitals seem to point to a lack of adequate human resources for
effective health care delivery The extent of working-man hours lost in the findings of the
research suggest a high rate of absenteeism and not a good reflection of happiness as
suggested in the annual report Professional nurses are second to the administration
support in absenteeism at 208 at a total of (n=785) nurses in the four hospitals with
absenteeism of n=3088 working-man days lost or n=20704 working-man hours lost This
category of employees is classified as skilled to highly skilled at salary range of 4 to 12The
total vacancy rate was at 697 as against the national target at 15 in 2008 with
absenteeism of 208 Madibana (201022) found in the research about absenteeism
among nurses that the high rate of absence had a negative impact in the quality of health
care rendered by nurses
4513 Staff nurses
Staff nurses are reflected in tables 4 and 5 as representing 12 (n=482) of the total working
population (n=4010) The 132 (n=1956) indicates the number of working-man days lost
in relation to the total working-man days lost (n=14840) times the percentage
The percentage of working-man days lost in relation to the total number of full time
employees in the four hospitals is reflected as 488 The cost to the Department is
expressed as direct and indirect salary expenditure for n=15648 working-man hours lost
The impact of leave of absence to health care services and cost to the Department is the
same as the professional nurses as staff nurses are a sub-category of the nursing profession
4514 Nursing assistants
Nursing assistants are reflected in tables 4 and 5 as represented by 107 (n=429) of the
total working population (n=4010) and 97 (n=1446) represent working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The
percentage of working-man days lost is reflected as 36 (n=1446) in relation to the total
number of employees in the four hospitals (n=4010)
51
The cost of leave of absence to the Department is expressed as the salary expenditure at
salary levels 3 to 6 Salary level 3 is at R54 876 salary level 4 is at R64 410 salary level 5 at
R76 194 and salary level 6 is at R94 000 for n=11568 working-man hours lost and staff
replacement and overtime
4515 Finance officers
Finance officers are reflected in tables 5 and 7 as represented by 21 (n=83) of the total
working population (n=4010) and 26 (n=386) indicates the working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The cost to the
Department is reflected as salary expenditure from salary level 2 at R47 787 to salary level
10 at R217 482 for R2 728 working hours lost The institutions reflected a small number of
this occupational category as permanent employees place them in the category of scarce
skills
4516 Administration staff
The administration staff is represented in tables 2 and 4 and 5 by 116 (n=466) in the total
working population (n=4010) and 153 (n=2272) indicates the working-man hours lost in
relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 567 represent the working-man days lost in relation to the total number of
full time employees in the four hospitals (n=4010) The cost of leave of absence to the
department is reflected as salary expenditure at salary level 4 to 12 Salary 4 at R64 410 to
salary level 12 at R407 745 for 18176 working hours lost
4517 Administration support
The administration support is reflected in tables 2 and 4 and 5 as represented by 273
(n=1095) of the total working population 354 (n=5248) indicates the working-man days
lost in relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 1309 (n=5248) indicates the working-man days lost in relation to the total
number of employees in the four hospitals (n=4010) The total cost to the Department is
reflected as salary expenditure at salary level 2 to 3 at a cost of R47 787 to R54 879 for
41984 working -man hours lost
The highest percentage of absenteeism in the different categories of employees in the four
hospitals is identified in the administration support category It is this category that falls into
the salary range of 2 and 3 which is classified in the Gauteng Province 20089 annual report
(20089325) as lower skilled employees This category represents the highest single
category of employees for the Department at n=1095
52
The impact to the core service delivery employees that require support from administration
staff would seem to be negative as the absence of employees from the workplace would
hamper the smooth workflow Barker (2007214-224) acknowledges the decline in the flow-
through rate in the school education higher grades namely Grade 11 and Grade 12 and
ventures to give possible reasons for this phenomenon The Gauteng Department of Health
as a possible employer has attracted a high percentage of the labourer category as
identified in table 3 totalling n=1095 which is 273 of the total workforce Pousette and
Hanse (2002230-231) suggest that the employeersquos authority to make decisions in his or her
job and the breadth of use of skills used by the employees at work become different aspects
of control with human service at work This approach suggests that reduced job autonomy is
associated with higher sickness absence The administrative support employees are involved
in mechanical or manual labour that predisposes them to musculo-skeletal problems The
work environment could have a negative impact to the high absenteeism rate in this group
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM AS REPRESENTED BY
THE HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 43 reflects the absenteeism rate of the different occupational groups as represented
by the hospitals The George Mukhari Hospital contributes 7079 to the total workforce
and contributes about 779 to absenteeism The absenteeism rate does seem to be low at
7 when considered in the light of the contribution The question that maybe be raised is
whether the relative low absenteeism is indicative of high morale of a happy workforce
53
ODI 17
TARA 93
GERMISTON 111
GEORGE MUKHARI 779
Germiston Hospital contributes 106 to the total workforce and the absenteeism is
reflected as 111 which seems to be above its contribution to the workforce by 1 The
professional nurse and the administration category present with the highest rate of
absenteeism in this hospital The Tara Moross Centre Hospital contributes 67 of the total
workforce and the absenteeism rate is at 93 which is 26 higher The administration
support and professional nurses present with the highest level of absenteeism in this
hospital The ODI Hospital contributes 6 to the total workforce and the absenteeism rate
which seems to be low is reflected as 17 This hospital has no access to the Persal system
and is dependent to a neighbouring hospital It is highly probable that the information is not
accurate
Allen (1984 331) found that union members might be absent more frequently from the
workplace than non-members because they face smaller penalties for absenteeism The
Charted Institute of Personnel and Development (CIPD) (200811) claim that the 2006
survey of absence management portrays the public sector employees as less likely to be
dismissed for reasons of workplace absenteeism
TABLE 8 SALARY RANGE IN RELATION TO ABSENTEEISM (SALARY RANGE 1-12)
SALARY RANGE DAYS OF ABSENCE PERCENTAGE
1-2 178 12
3-4 5235 353
5-6 2044 138
7-8 5139 346
9-10 1878 126
11-12 366 25
TOTAL 14840 100
(Source Compile by the researcher C S Ndhlovu 2012)
Table 8 reflects the salary range with the lowest working days lost as salary level 1 to 2 This
is proportional to the number of employees The highest absenteeism rate has been noted
in the salary range at level 3 to 4 while salary ranges at level 11 to 12 reflected a low rate of
absenteeism The latter salary range is at middle management level and the responsibility
the employees carry may be responsible for the low absenteeism rate Rogers and Hertin
(1993219) noted that the level of education seem to have influenced the use of sick leave
where the lower level category employees were found to have higher level of absenteeism
than higher educated employees
54
TABLE 9 AGE IN RELATION TO ABSENTEEISM
AGE IN YEARS DAYS OF ABSENCE PERCENTAGE
20 to 24 16 010
25 to 29 405 272
30 to 34 733 493
35 to 39 1582 1066
40 to 44 2676 1803
45 to 49 3318 2235
50 to 54 3046 2052
55 to 59 2235 1506
60 to 64 829 558
TOTAL 14840 9999(100)
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 9 reflects age in relation to absenteeism in the four hospitals The age group at 20 to
24 years reflects the lowest figure in working-man days lost at 010 (n=16 days)
Reday-Mulvey (200579) observed that employees over 45 years take marginally fewer short
sick leave days per year than those under 45years
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 to 55 years
as middle -age and shows this group as presenting with a high incapacity leave usage In the
research the age group 45 to 49 years presented with 2235 (n=3318) working-man days
lost and is the highest figure of absenteeism in all age groups The age group at 20 to 24
years is reflected as the lowest absenteeism rate in working-man days at 010 and this
could be related to the number of employees in this age group
According to Reday-Mulvey (20057988) and the Canadian Nurses Association (20065)
employees that are over 45 years take marginally fewer short sick leave periods but take
slightly longer sick days per year than those under 45 years and reflect higher absenteeism
in the age group above 50 years
55
Weeks (200454) found that employees at the age group represented by 51 to 60 years
show less absence which may be because of ill health retirement benefits The age 31 to 40
and 41 to 50 years show higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full time jobs and suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee In the study the age group 55 to 59 years show a decline in absenteeism in
comparison to 50 to 54 while age 60 to 64 shows the lowest rate
The aging employee has been found to expose the institutions to high levels of absenteeism
through a higher probability of becoming incapacitated for longer periods (Ferguson et al
200138) and the current research have pointed differently Rogers and Hertin (1993219)
found a significant correlation between the use of sick leave and age suggesting employees
with advanced age used more sick leave in comparison with the younger employees The
current socio-economic culture encourages retirement from active employment at the age
of 65 years and the research adopted that approach as a cut off point for employment
(Nichols amp Evangelisti 2001285)
TABLE 10 GENDER IN RELATION TO ABSENTEEISM
GENDER TOTAL
NUMBER
DAYS OF
ABSENCE
PERCENTAGE
Males 1006 2490 168
Females 3004 12350 832
Total 4010 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 10 reflects gender in relation to absenteeism The duration of working-man days lost
is higher in female employees at 8325 (n=12350) and is represented by 749 (n=3004) in
relation to the total number of employees in the four hospitals (n=4010) as represented in
table 3 The male employees employed by the Department are reflected as absent from
work by 1680 (n=1006) and represented as 251 in relation to the total number of
employees in the four hospitals (n=4010)
The Public Service Commission (PSC 200222) found that more males took sick leave than
females except for the age group of 16 to 19 years QUALSA (200923) noted that females
had the highest number of incapacity applications in comparison to their male counterparts
Qualsa attributed this pattern to the fact that female employees constitute a higher
percentage of the employee population within the Gauteng Department of Health
56
Roger and Hertin (1993222) noted that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees could have an
impact on the high number of absenteeism reflected by the women
452 Race in relation to absenteeism
The working population of the four hospitals is represented by four race groups such as
Africans Whites Coloureds and Indians
4521 Africans
Africans represent 973 (n=3902) of the total working population (n=4010) and 963
(n=14295) indicates the working-man days lost in relation to the total working-man days
lost (n= 14840) times the percentage 3565 (n= 14295) reflects the working-man days
lost in relation to the total number of employees in the four hospitals (n=4010) The 14295
working-man days lost are multiplied by 8 hours that represent a day and translates into
963 (n=114360) working-man hours lost The cost to the Department is translated as
salary expenditure for n=114360 workingndashman hours lost and the indirect cost of staff
replacement and overtime Africans constitute the highest number of employees as well as
the highest percentage of working-man hours lost Absenteeism percentage is proportional
to the employment figures for this race group
4522 Whites
Whites are represented as 13 (n=51) of the total workforce (n=4010) and 16 (n=242)
represent the working-man days lost in relation to the total working-man days lost
(n=14840) times percentage 61 (n=242) represent working- man days lost in relation to
the total number of employees in the four hospitals The 232 working-man hours lost are
multiplied by 8 hours that represent a working- man day that translates into 16 (n=1856)
working-man hours lost The cost to the Department is represented as salary expenditure of
(n=1856) working-man hours lost that is paid to the unproductive employees This race
group of employees is not represented in all occupational categories and salary ranges
which may explain the low figures and percentages associated with working-man days lost
(n=242) The demographics of the different hospitals may contribute to the low
representation of this group in the total workforce
4523 Coloureds
Coloureds are reflected as 11 (n=43) of the total workforce (n=4010) 14 (n=201)
represent working- man days lost in relation to the total working- man days lost (n=14840)
5 (n=201) indicates working- man days lost in relation to the total number of employees in
the four hospitals (n=4010)
57
The cost to the department is represented as salary expenditure for n=1608 working-man
hours that are lost This race group is represented in three of the four hospitals and not in
all categories and salary ranges which may explain the low representation and
absenteeism
4524 Indians
Indians represent 03 (n=14) of the total workforce (n=4010) in table 6 07 (n=102)
represent working- man days lost in relation to the total working- man days lost (n= 14840)
times percentage 25 (n=102) indicates working- man days lost in relation to the total
number of employees in the four hospitals (n=4010) The 102 working- man days lost are
multiplied by 8 hours that represent a working-man day and translates into 07 (n=816)
working- man hours lost The cost to the Department is expressed as salary expenditure
paid to the unproductive employees for duration of (n=816) working-man hours lost This
race group is not represented in two of the four hospitals in some occupational categories
and salary ranges The Indian race group is represented by the lowest figure of employment
and lowest percentage of leave of absence which is proportional to the employment figure
FIGURE 44 RACES IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 44 reflects the different races in relation to absenteeism The Africans as a race
group is represented by 963 of working-man days lost (n=14840) The high figure of lost
working-man days reflects the demographics of the four hospitals
58
14840 DAYS
(100)
Africans 963
whites 16
coloureds 14
Indians 07
The George Mukhari Hospital is in a semi-rural setting that is predominantly African
populated and employs the highest number of Africans as represented in table 1 (n=2836)
Whites are presented by 16 absenteeism rate and not represented in all occupational
categories and salary ranges which could explain the low figures and percentages associated
with lost working days The absenteeism rate for Indians is represented as 07 and
Coloureds as 14
The Africans as a race group constitute the highest number of employees as well as the
highest percentage of working days lost Absenteeism percentage is proportional to the
employment figures for this race group The Indian race group is represented by the lowest
figure of employment and lowest percentage of leave of absence which is proportional to
the employment figure The South African Survey Millennium (1999-200028) reflected the
African males in 1998 as 354 and females as 348 the Coloured males as 39 and
females as 46 Indian males as 39 and females as 15 and White males as 83 and
females as 94 There has been no significant change in the race group representation in
the working population of the four hospitals
453 Tenure in relation to absenteeism
Tenure in years is grouped in units of ten (10) Tenure in 1 to 10 years 11 to 20 years 21 to
30 years 31 to 40 years of all occupational groups are represented in figure 27 as the total
leave of absence utilised by the full-time employees of different occupational groups in
terms of tenure which translates into n=14840 working-man days lost The lowest hours lost
is at tenure 31 to 40 years of service which is reflected as 59 (n=878) working- man days
lost The highest working-man days lost is at tenure of service of 11 to 20 years reflected as
443 (n= 6577) working- man days lost Tenure of service of 1 to 10 years reflects 30
(n=4451) working-man days lost and tenure of years at 21 to 30 years reflects 198 (n=
2934) working- man days lost
Rogers and Hertin (1993222) express tenure as work experience in years that is viewed as a
predictor of employee productivity where seniority has been found to be inversely related to
absenteeism in terms of frequency and total number of work days lost The Canadian Nurses
Association (20065) suggests that job tenure increases with age as illustrated in their
research where nurses were found to have both job tenure of 20 years or more and are over
45 years of age In the research the tenure of 31 years to 40 years presented with the lowest
absenteeism rate in agreement with Rogers and Hertin (1993222)
59
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 45 reflects the total leave of absence from tenure of 1 year to 40 years The PERSAL
system reflected 40 years as representing more or less 64 years of age and 65 years is the
cut off point for full time employees in the system The lowest working- man days lost is at
tenure of 31 to 40 years of service which is reflected as 590 and represents the older
employee in general The highest working- man days lost is reflected at tenure of 11 to 20
which is presented as 4430 representing the younger employee This is an area of concern
as table 5 reflects professional nursesrsquo absenteeism rate at 208 and administration
support staff at 356 and is possible that the absenteeism rate of the two occupational
categories may be a bigger contributor to the high absenteeism rate reflected in the tenure
of 11 years to 20 years
454 Salary range in relation to absenteeism
The salary range is interpreted in the study as a salary broad band that is represented in
table 9 and ranges from level 1 to 12 Rogers and Hertin (1993 219) claim that the level of
education does seem to have a bearing on the salary range use of sick leave where the
lower level category employees were found to have higher levels of absenteeism than the
higher educated employee The Human Resource Development Strategy (Gauteng Province
200815214) claims that the chances of entering into a higher income bracket in South
Africa rises noticeably after people have twelve years of education The ages 20 to 24 years
are greatly affected by this assumption
60
0
20
40
60
Tenure 1-10Tenure 11-20
Tenure 21-30Tenure 31-40
30 4430
1980
590
Tenure
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 46 above reflects the salary range from 1 to 12 in relation to working- man days lost
as salary range 1 to 2 as n=178 working-man days lost which converts to 12 The highest
absenteeism rate has been noted in the salary range at level 3 to 4 at 3530 (n=5235)
working-man days lost while salary ranges at level 7 to 8 is reflected as the second highest
level of absenteeism at 346 (n=5139) lost working-man days
Salary range at 5 to 6 is reflected as the third highest in absenteeism at 138 (n=2044) lost
working-man days Salary range 9 to 10 is regarded as the entry point to middle
management and is reflected as the fourth highest at 126 (n=1878) working-man days
lost Salary range at 11 to 12 is regarded as middle management entrusted with high levels
of authority and accountability This group is reflected as losing 25 (n=366) working- man
days lost which is considered to be a reasonable low level of absenteeism
455 Age of full time employees in relation to absenteeism
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 years to 55
years as middle-age and shows this group as presenting with a high incapacity leave usage
In the research the age group of 45 years to 49 years is represented with 2235 (n=3318)
working- man days lost and is the highest figure of absenteeism in all age groups
61
178
5235
2044
5139
1878
366
0
1000
2000
3000
4000
5000
6000
Salary range1-2
Salary range3-4
Salary range5-6
Salary range7-8
Salary range9-10
Salary range11-12
DAYS OF ABSENTEEISM
Reday-Mulvey (20057988) and Canadian Nurses Association (20065) observed that
employees over 45 years take marginally fewer short sick leave periods but take slightly
longer sick days per year than those under 45 years and reflect higher absenteeism in the
age group above 50 years
Weeks (200454) claims that the age group at 51years to 60 years show less absence may be
because of ill health retirement benefits The age group of 31 years to 40 years and 41years
to 50 years show a higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full-time jobs He suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee The aging employee has been found to expose the institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods
(Ferguson et al 200138)
Rogers and Hertin (1993219) claim that there is a significant correlation between the use of
sick leave and age suggesting employees with advanced age comparatively used more sick
leave in comparison with the younger employees The current socio-economic culture
encourages retirement from active employment at the age of 65years and the research
adopted that approach as a cut off point for employment (Nichols amp Evangelisti 2001285)
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 47 reflects the number of working-man days lost by full-time employees through
absenteeism related to a specific age
62
16
405
733
1582
2676
3318
3046
2235
829
0
500
1000
1500
2000
2500
3000
3500
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Days of absence
Days of absence
Age groups are organised in units of 5 to be consistent with the Personnel and Salary
Administration System (PERSAL) The age group at 20 years to 24 years reflects the lowest
percentage of absenteeism at 010 (n=16) working-man days lost and the age group of 45
years to 49 years reflect the highest days of absenteeism at 2235 (n=3318)
456 Gender in relation to absenteeism
The females employed in the Department of the four hospitals are represented as 749
(n=3004) in relation to the total number of employees in the four hospitals (n=4010) and
lost 8320 (n=12350) working-man days This absenteeism rate is considered high
considering that not every female employee may have used sick leave The male employees
employed in the Department are represented by 25 (n=1006) of the total workforce
(n=4010) and lost 168 (n=2490) working-man days The findings suggest that males
utilised fewer days of sick leave considering the fact that not every male employee may
have utilised sick leave for the duration of the study
The Public Service Commission (PSC 200222) claims that more males took sick leave than
females except for the age group of 16 years to 19 years QUALSA (200923) noted that
females had the highest number of incapacity applications compared to their male
counterparts Qualsa attributed this pattern to the fact that female employees constitute a
higher percentage of the employee population within the Gauteng Department of Health
Rogers and Hertin (1993222) argue that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees may have an
impact on the high rate of absenteeism
63
FIGURE 48 GENDER IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 48 reflects gender in relation to absenteeism The females employed by the
department in the four hospitals are reflected as absent from work at a rate of 8320
(n=12350) working-man days and represented by 749 (n=3004) in relation to the total
number of employees (n=4010) in the four hospitals The male employees employed by the
Department are reflected as absent from work at 1680 (n=2490) and represented as
251 (n=1004) in relation to the total number of employees in the four hospitals
(n=4010)
457 Week days in relation to occupational groups
Table 11 reflects the trends in terms of days of the week that show high utilisation by the
different occupational groups Mondays Fridays and Thursdays reflect a high utilisation rate
by the employees suggesting a pattern of high absenteeism rate over weekends
Professional nurses and sub-categories and the administration support group reflected the
highest absenteeism over the weekends
64
1680
8320
000
1000
2000
3000
4000
5000
6000
7000
8000
9000
Males Females
GENDER ABSENCE
TABLE 11 WEEK DAYS IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
OCCUPATIONAL
CATEGORY
MONDAY TUESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Doctors 18 8 13 17 0 0
Professional
Nurse
135 86 94 137 0 0
Staff Nurse 52 38 56 65 2 0
Nursing
Assistant
62 27 34 45 2 0
Administration
Staff
64 38 58 73 1 0
Administration
support
252 147 98 126 26 15
Finance officer 17 4 8 16 0 0
TOTAL 600(4) 348(23) 361(24) 479(32) 31(02) 15(010)
(Source Compiled by C S Ndhlovu 2012)
Table 11 reflects the pattern of how the different occupational groups utilised sick leave on
the different days of the week It illustrates the days that sick leave started on each day of
the week The largest number of incidences of sick leave commence on Monday the first
working day of the week as reflected by 4 (n=600) of the days of the weekend Fridays are
the second highest days of absenteeism represented by 32 (n=479) Tuesdays and
Thursday are almost the same in utilisation as reflected by 23 and 24 respectively
Professional nursesrsquo absenteeism was pronounced on Mondays as 2250 (n=135) and
Fridays as 2861 (n=137) a trend that shows possible long weekend absenteeism
The administration support staff has been reflected as mostly absent on Mondays 42
(n=252 days) and Fridays 2631 (n=126 days) The administration support reflected the
highest days of absenteeism on Saturday (n=26) and Sunday (n=15) The Canadian Nurses
Association (CNA) (2006) focused on seasonal pattern of absenteeism in the different
categories in the different hospitals The PSC (2002) report identified a trend by provincial
employees of using sick leave to extend their weekends The research considered working-
man days lost in terms of days of absence as in accordance with evidence of a medical
certificate Administration support is the only group that seem to have utilised Saturdays
for sick leave 8387 (n=26) and Sundays 100 (n=15) days
65
TABLE 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALS
INSTITUTIONAL
CONTRIBUTION
TARA MOROSS
CENTRE
GERMISTON ODI GEORGE
MUKHARI
TOTAL
Contribution to
Sample
668 1070 1182 7080 100
Contribution to
Absenteeism
842 1177 165 7816 100
(Compiled by C S Ndhlovu 2012)
Table 12 reflects the contribution of each hospital to absenteeism Tara Moross Centre
Hospital contributed 67 to the sample and the absence rate is higher than the
contribution at 84 The Germiston Hospital contributed 107 to the sample and the
absenteeism rate is higher at 117 The George Mukhari Hospital contributed 708 to the
sample and absenteeism rate is at 782 and ODI Hospital contributed 118 and
absenteeism rate is at 17 The latter hospital has no computers at The reflection of the
status of absenteeism is likely to be inaccurate The George Mukhari Hospital has the
highest contribution to the sample yet leave of absenteeism is tolerable It raises questions
as to what should be the contributory factor to the leave of absence status in this hospital
46 CONCLUSION
Chapter 4 presented the analysed data in terms of the characteristics as determined in the
stratified random sampling The characteristics and their association with absenteeism have
been presented such as occupational categories age gender tenure of service and race
The research identified which days of the week were utilised for sick leave absence The
contribution of each hospital to absenteeism was identified and a brief overview of each
hospital was presented
Chapter 5 presents the findings conclusion and recommendation of the research
66
CHAPTER 5
FINDINGS CONCLUSIONS AND RECOMMENDATIONS
51 INTRODUCTION
Chapter 1 provides a general introduction to the research It included the background and
motivation for the research that provides the context the problem statement and the
significance of the research The key concepts are defined The research design the method
of data collection the sampling method data analysis and interpretation and limitations to
the research are explained in this chapter
Chapter 2 considers the theoretical foundations concepts characteristics theories
approaches and classifications of workplace absenteeism The discussions on the conceptual
framework of absenteeism predictors of absenteeism and various models of absenteeism
are presented Measures to control workplace absenteeism and the impact of absenteeism
in an institution and management intervention strategies in workplace absenteeism were
discussed
Chapter 3 describes the research design and the different aspects of the research methods
that were applied to the research The chapter explains the various data collection
techniques that are used unit of analysis units of observations construct validity and
ethical considerations
Chapter 4 provides the organisational structure of the Gauteng Department of Health
comparisons of hospital employees different race groups of the four hospitals gender
comparisons in different hospitals and comparisons of the different occupational groups It
provides a short description of the target hospitals The research interpretation is discussed
in terms of the different occupational groups and absenteeism different races and
absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism The trends of week days of
absenteeism in the four hospitals and contributions to absenteeism by the four hospitals are
presented
Chapter 5 explains a synthesis of the study and evaluation of workplace absenteeism The
findings of the research and recommendations are discussed
52 FINDINGS
The findings of the research reflect doctors as represented by 108 in the total workforce
(n=4010) have an incidence of 29 (n=435) of the total work-man days lost (n= 14840) by
the employees in the four hospitals translating to a total of n=3480 working hours lost
67
The working-time lost is considered against the doctorsrsquo workload of 226 in contrast to the
target of as 227 while the national target was 187 The bed occupancy rate target was 75
while the actual figure was 653 The annual report when it is interpreted in conjunction
with the sick leave absence of doctors at 29 shows no negative impact on the workload in
terms of service delivery The negative impact is mainly on the cost factor to the state as the
doctorrsquos salary level is from salary level 10 at a cost of R217482 to salary level 12 at
R407745 (Gauteng Province annual report 2008951) Serneels et al (2008210) claim that
absenteeism occurs primarily in the public sector associated with people who hold two jobs
and that is highest and more frequent amongst doctors The findings of the research of
absence of 29 with a contribution of 2 to the sample are in disagreement with the
Serneels et al findings
Professional nurses represent 196 (n=785) of the total workforce (n=4010) The
workplace absenteeism is represented as 77 (n=3088) of the total workforce (n=4010)
translating into 21 of working-man days that are lost (n=14840) The absenteeism rate
appears to be very high given the fact that nurses by virtue of their numbers are the
backbone of health care service delivery (DPSA 2009) The Gauteng Province annual report
of 2008951 reflects the total vacancy rate of nurses at 697 as against the national target
of 15 The absenteeism rate of 77 is very high when compared with the total vacancy
rate and 19 contribution to the sample Staff nurses are a sub-category of the nursing
profession and the impact of their absence to service delivery is the same as the
professional nurses The findings of the study reflect staff nurses representing 12 (n=482)
of the total working force (n=4010) The absenteeism from staff nurses is reflected as 13
(n=1956) of the total working-man days lost (n=14840) The absenteeism rate does appear
to be high when considering the contribution of 13 to the absence rate by a sample of 12
to the total working-man days lost Nursing assistants are a sub-category of the nursing
profession that is reflected as 107 (n=429) of the total number of employees (n=4010)
and represent 97 (n=1445) of the total working-man days lost (n=14840) This absence
rate is considered as high when compared with the total number of employees
The nursing occupational group considered collectively contributed to absenteeism at the
workplace at 997 which is extremely high Davey and Cummings (2009312-313) claim
that frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased
staff morale and high cost to health care The high absenteeism rate has a negative impact
on health care service delivery
The findings of the research reflect administration staff as 116 (n=466) of the total
number of employees (n=4010) represented by 154 (n=2286 days) of the total working-
man days lost (n=14840) Administration support is at salary level 1 to 2 with exceptional
instances of salary level 3 to 4
68
Administration support staff is reflected as 273 (n=1095) of the total workforce (n=
4010) represented by 356 (n=5289 days) of the total working-man days lost (n=14840)
translating to n=42312 lost working-man hours
The administration staff viewed collectively contributed 51 to absenteeism which is very
high with the support staff reflected as 356 Rogers and Hertin (1993219) claim that the
level of education seem to have influenced the use of sick leave where the lower skilled
category of employees were found to have higher levels of absenteeism than higher
educated or skilled employees The findings of the research reflect the administration
support staff to be in line with the Roger and Hertin findings
The Gauteng Department of Health has a limited number of finance officers causing them to
be a scarce skill occupational group The finance officers represent 2 (n=83) of the total
workforce (n=4010) The working-man days lost are reflected as 23 (n=341) of the total
working-man days lost (n=14840) The total absence at 23 is higher than the actual
contribution to the sample at 2
The age group of 45 years to 49 years reflects the highest absenteeism rate at 224
(n=3318) the age group at 50 years to 54 years is reflected as 205 absenteeism The age
group 40 years to 44 years reflected as 18 absent from the workplace The age group of 55
years to 59 years is reflected as 15 absenteeism Employees of advanced age used more
sick leave in comparison with the younger employees This phenomenon could be attributed
to the ageing process of the body and the onset of incapacity Absenteeism has been found
to be higher in employees who are over 50 years of age and the phenomenon is attributed
to age and changing abilities that increase when work is performed full- time The findings
of the research reflect the age group over 50 years at 205 and reflect the highest
absenteeism rate at age 45 years to 49 years as 224 (McGoldrick amp Arrowsmith 200184
MINTRAC 20093 Nichols amp Evangelisti 2001285 Reday-Mulvey 200579-194) According to
Ferguson et al (200138) the aging employee presents with high levels of absenteeism
through higher probabilities of becoming disabled for longer periods The findings of the
study reflect absenteeism of the age group of 55 years to 59 years at 15 which is the
lowest in the age groups The Canadian Nurses Association in (20065) noted a reduction in
workplace absenteeism rate among nurses who are less than 45 years of age and an
increase in the absenteeism rate among nurses above 55 years of age According to Bangali
(20043-4) the falling rate of the older employee age group could be influenced by the
practice of early retirement or voluntary severance which was used in the 1990s as a
method of restructuring in institutions Rogers and Hertin (1993219) claim employees with
advanced age used more sick leave in comparison with the younger employees
69
The group at tenure 11 to 20 years presented with the highest level of absenteeism at
443 The employee at tenure of 21 to 30 years presented with 198 of absenteeism rate
while the employees at 1 to 10 years presented with the rate of 30 The findings of the
research reflected tenure of 31 to 40 years to have presented with the lowest absenteeism
rate at 59 (n=878 days) This low absenteeism rate could be ascribed to the fact that
numbers of employees are reduced in this group or could also be commitment to their jobs
or could have higher ambition levels to aspire to higher posts
Van Der Westhuizen (2006136) and Rogers and Hertin (1993222) express tenure as work
experience that may be viewed as a predictor of employee productivity where seniority has
been found to be inversely related to absenteeism in terms of frequency and total number
of working-man days lost The public service employees enjoy security of tenure which may
contribute to the unacceptably high levels of absenteeism (Andrews 1997221ndash222
MINTRAC 20093)
The findings of the research reflect females as 75 of the total workforce (n=4010)
represented by 832 (n=12350) of the total working-man days lost (n=14840) The males
represent 25 of the total workforce (n=4010) and are reflected as absent at 168
(n=2490) of the total days of absence (n=14840)The absenteeism rate is very high for
females in this research Rogers and Hertin (199322) and Van Der Westhuizen (2006136)
suggest that women are absent from workplace more than men are Landstad et al (20011)
found that women cleaners who received preventive personnel support depicted a
reduction in absenteeism rate Hoxsey (2010562) claims that although women presented
with a high score of job satisfaction than men they maintained higher levels of
absenteeism MINTRAC (20094ndash8) found that gender moderates the age turnover
relationship Women are more likely to remain in their jobs the older they get than men do
The findings of the research reflect Africans as represented by 26 of the working
population and utilised 963 of the total working-man days lost due to sick leave It is
possible that the overall number of Africans influenced what seems to be a high level of
absenteeism at 963 Whites represented 03 of the working population and
absenteeism is reflected as 16 of the total working-man days lost Coloureds are
represented by 03 of the working-man population and absenteeism was recorded as 14
of the working-man days lost The Indians are represented by 01 of the total working
population and are reflected as 07 of the working-man days lost
The findings of the research reflect the salary range at level 11 to 12 utilised 25 working-
man days for sick leave salary level 7 to 8 which is the supervisory level utilised 346
working-man days lost salary level 3 to 4 which is the entry level of skilled workers utilised
353 working-man days lost The findings suggest management used fewer days of sick
leave in comparison to the supervisory level and entry skilled worker level
70
This can be ascribed to the fact that they are ultimately responsible for the institutionrsquos
effectiveness and productivity
The George Mukhari Hospital contributed 708 to the sample and reflected 771
absenteeism which is relatively low in comparison to the size of the contribution It could be
that processes and procedures of controlling leave of absence are in place The Tara Moross
Centre Hospital contributed 67 to the sample and reflected 93 absenteeism rate that is
high by 26
Professional nurses reflected a trend of high absence over the weekend including
Thursdays This could be a sign of burn out and extending the period of rest from possible
high workloads resulting from high vacancy rates (Gauteng Province annual report 20089)
Nyathi (200059) and the PSC (2002) found that employees are absent from work because
they want to prolong the weekend
53 CONCLUSIONS
The absenteeism rate is very high for females in this research The aging employee presents
with high levels of absenteeism through higher probabilities of becoming disabled for longer
periods The use it or lose it approach of the current system rewards the abuse of sick leave
as it is viewed as not being beneficial by the employees to act responsibly towards the use
of sick leave
The vacancy rate of 697 in the professional nurse category and the absence rate of 208
in 2008 in the four hospitals can only suggest inadequate levels of human resource for
effective efficient quality health care services at a high cost to the Province The nurses
may not be aware of the actual absenteeism or they under-estimate it The combination of
high registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery
Professional nurses and administration support staff have absented themselves from the
workplace predominantly on Mondays and Fridays It could be for various reasons ranging
from feelings of burn out to extending the weekend
The percentage of working-man days lost in relation to the total number of full-time
employees in the four hospitals is reflected as 488 which is very high as there is no
deterrent not to abuse sick leave in the public sector The findings of the research found a
significant correlation between the occupation and use of sick leave age and the use of sick
leave gender and use of sick leave and tenure and use of sick leave
71
The biggest hospital George Mukhari presented the lowest rate of absenteeism for its size
and complexity which reflects an empowered management The Tara Moross Centre
Hospital is the smallest hospital highly specialised and presented with high rate of
absenteeism for its contribution which may be a reflection on the skills of its management
or the type of health care service that is offered by the institution
The international norm of absenteeism is 3 The research established the absence rate at
488 The Gauteng Department of Health is held at ransom by the five trade unions it has
signed agreements with and that makes it difficult for managers to manage absenteeism
The practise of Gauteng Department of Health Head office to remove managers from
institutions when there is a labour unrest exacerbates the problem of managing
institutions
The findings of the research could not establish a representative reflection of race and
absenteeism as Indians Coloured and Whites were not represented in some institutionsrsquo
demographics
54 RECOMMENDATIONS
The White Paper on Transforming Public Service holds management responsible for
delivering specific levels of services and for obtaining value for money in wider utilising of
resources This strategy is to be translated into action The Gauteng Department of Health
should probably benefit by adopting the total absence management philosophy by
cultivating a culture that is not tolerant of high levels of absenteeism through building it in
as a key performance area of the performance of all managers and all employees The
current performance dimension system should lay explicit emphasis on this aspect
The re-engagement of knowledge based and professional retirees at reasonable
remuneration levels to reward their expertise may assist in reviving good work ethics by
mentoring the new and generally young recruits The retired professionals are currently
resisting the call for re-employment on a contract basis at entry level
The Gauteng Department of Health can encourage flexitime in terms of 58 or 68 to allow
the mature employee to remain within the system with the view to share their knowledge
and skills with the young employees who may be highly qualified but lack experience This
approach may deal with the need for adequate human resources for health care delivery at
reduced cost as two employees on flexitime basis can occupy one full-time employeersquos post
Managers should use the return-to-work counselling strategy to solicit feedback from the
employee about the actual absenteeism The counselling should be on a one-to-one basis
This approach may raise self-awareness to the employees in terms of the impact of the
employeersquos absence frothed workplace
72
Currently this intervention strategy is not adequately utilised for fear of confrontation with
labour representatives
Managers should have attendance policies in place effectively communicate policies to
employees adhere to policies and procedures and use absence control strategies
consistently This approach will minimise the feeling of injustice by employees Currently the
human resource unit is challenged by a high staff turnover due to promotions from the
human resource area a situation that creates a vacuum and lack of continuity weakening
the process of empowering line managers by human resource practitioners This high staff
turnover may be controlled through upgrading of the human resource salaries as the
salaries fall out of the occupation service dispensation (OSD)
Managers in the public service are expected to be responsible and accountable for their
portfolios including management of leave of absence and should not shift it to the human
resource unit as is currently the practice It should be possible to charge a manager as an
accomplice for failing to manage the absence of employees where there is no evidence of
corrective remedial action where it has been warranted The researcher takes cognisance of
the fact that the public service is highly unionised and this approach may trigger industrial
action
The employer needs to revive on the job in-service education and training as a way of
imparting institutional values such as attendance at the workplace in partnership with
recognised labour representatives through bilateral and multilateral forums and through
institutional skills development committee which should be representative of all
stakeholders with the view to promote stability in the workplace and indirectly enhance
productivity and reduce workplace absenteeism Currently the bilateral multilateral and
skills development committees are inactive in the institutions that were targeted and
management seems to be intimidated by the militant labour representatives
High levels of absenteeism among some occupational groups do suggest a need for an active
employee assistance programmes at all hospitals Employee wellness committees are
currently inactive There is a sporadic intervention approach at some institutions where
PILIR Committees are active Employee assistance programmes should be budgeted for as a
standing on-going programme in all hospitals There is a need for a thorough research as to
why absenteeism remains high in the public service and focus on absenteeism broadly
73
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LexisNexis
Gaudine A amp Gregory C2010The accuracy of nursesrsquo estimates of their absenteeism
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Goldstein M2008Why measure service delivery Are you being serviced New tools for
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Jankowitz E 1991Terminating for absenteeism practical labour management Rivonia IR
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Landstad B Vinberg S Ivergard TT Gelin G ampEkholm J2001Change in pattern of
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LexisNexis 2006Labour Law Reports July 1994ndashDec2006CumulativeIndex Durban
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LexisNexis 2007 Legislation and strategyLexisNexis (9)Durban Butterworths Available at
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Madibana LF 2010 Factors influencing absenteeism amongst professional nurses in
London Pretoria University of South Africa
Markussen S Rogeberg OJ amp Gaure S 2009 The anatomy of absenteeism IZA
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McCormick ET amp Ilgen D1985 Industrial and organizational psychology 8th edition New
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McGoldrick E amp Arrowsmith JJ 2001Discrimination by age the organizational response
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Mellor N Arnold Jamp Gelade G2009The effects of transformational leadership on
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Mouton J2005How to succeed in your Masterrsquos and Doctoral studies a South African guide
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workplace JohannesburgUniversity of Johannesburg
81
ANNEXURES A B C
ANNEXURE A
PROCESS EVALUATION QUESTION COMPLIANCE
YESNO
ACTION PLAN
Retention and Reward -
leave
1 Are there complete and
accurate Z 1(Leave application
forms) forms on file
2 Have all application forms been
approved stamped and
registered
3 Have all forms been captured
on the Persal with the following
requirements
Supporting documents
A 10 day compulsory leave
processed within the annual
leave cycle Determination of
Leave
4 The remaining days are utilized
6 months from the end of the
leave cycle
5 Are there unutilized leave days
6 Has there been adequate
checking of leave reasons
Leave credits
Adherence to leave categories
(i)Normal ( ii) Incapacity
(iii) Injury on duty (iv) Maternity
(v)Adoption (vi) Family
responsibility
(vii) Office bearersshop stewards
and Casual Employees
7 Have work reasons been
provided for leave days
(Source Compiled by C S Ndhlovu 2012)
82
ANNEXURE B
Retention and
reward ndashsick leave
Evaluation Question Compliance YesNo Action Plan
1 Are there medical
certificates that have been
submitted to all medical
claims with the following
Specific illness stated
Supporting documents on
file
2 Has the 8 week rule for
36 days in a 3 year cycle
been adhered to
3 Are there complete
medical certificates for 3
days or more sick leave
days for normal sick leave
4 Are all other leave days
above 3 days utilized after
36 days treated as
temporary incapacity
leave
5 Are temporary
incapacity leave forms
submitted within 5 working
days after the first day of
absence
6Is there a register for
temporary incapacity
leave for 1 to 29 days lead
time for reporting leave
applications
7 Has the employer
approveddeclined the
leave application within 30
working days of receipt
(Source Compiled by C S Ndhlovu 2012)
83
ANNEXURE C
CHECK LIST
Is there a leave register in place for all leave applications
1 Is leave approved prior to the employee proceeding on leave
2 Area attendance registers maintained and up to date
3 Are periodic audits for leave carried out
4 Is there evidence of GSSCrsquos approval on leave applications
5 Are leave forms accurately captured on Persal
6 Are leave forms accurately completed by applicants
7 Is movement of leave forms monitored between the GSSC and institutions
8 How is rejected leave application dealt with
(Source Compiled by C S Ndhlovu 2012)
84
LIST OF FIGURES
FIGURE 21 CONCEPTUAL FRAMEWORK MODELhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
FIGURE 22 MODEL SPECIFICATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
FIGURE 41 INTEGRATED ORGANISATIONAL STRUCTUREhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip53
AS REPRESENTED BY THE HOSPITALS
FIGURE 44 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip58
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip60
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip61
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALShelliphelliphelliphelliphellip62
FIGURE 48 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip64
X
LIST OF TABLES
Table 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
Table 2 COMPARISONS OF NUMBERS OF ADMINISTRATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
AND SUPPORT STAFF IN THE DIFFERENT HOSPITALS
Table 3 GENDER COMPARISON IN DIFFERENT HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Table 4 COMPARISON OF TENURE OF SERVICE IN RELATION TOhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
ABSENTEEISM IN THE FOUR HOSPITALS
Table 5 COMPARISON OF THE OCCUPATIONAL GROUPShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip45
IN THE DIFFERENT HOSPITALS
Table 6 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip48
Table 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Table 8 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip54
(SALARY RANGE 1-12)
Table 9 AGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip55
Table 10 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Table 11 WEEK DAYS IN RELATION TO ABSENTEEISM INhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip65
THE FOUR HOSPITALS
Table 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphellip66
IX
CHAPTER 1
GENERAL INTRODUCTION
11 INTRODUCTION
The Gauteng Province is viewed as a province of opportunities by South Africans as well the
neighbouring countries such as Mozambique and Zimbabwe The impact of these
perceptions has placed a heavy demand on services including health provided within the
confines of the province the results being an increase in the workload of the employees
The indirect results of the increase in the workload have been unacceptably high levels of
absenteeism seemingly sub-standard levels of health care and high cost of delivering the
health care services Absenteeism poses a threat and can lead to the collapse of health care
services if absenteeism is poorly managed The research examines the management and
control of absenteeism in four out of thirty four hospitals that service the province The
hospitals that have been targeted for the research are ODI District Hospital Germiston
Hospital TARA Moross Centre Hospital and George Mukhari Hospital
This chapter explains the background and motivation for the research The research
highlights the problem statement which focuses on the effective management of
absenteeism The objectives of the study the research methodology and structure of the
research are explained The relevant literature review was consulted for the research The
key concepts that are used in the research are conceptually defined The research design is
a descriptive stratified random survey The data that were used were collected in three
phases the unit of analysis were the employees of the Gauteng Department of Health in the
four target hospitals and the unit of observations were observations of the employees of
the four hospitals The construct of validity was achieved through using a variety of data
collection methods Ethical considerations were taken into account during the research
process Limitations of the research were imposed by the uniqueness of each of the target
hospitals The structure of the research and the reference technique is explained in this
chapter The research on absenteeism in the Gauteng Department of Health is confined to
the period of 1 January 2008 to 31 December 2008 and focused on the working-man days
lost how absenteeism is managed and employee well-being and rehabilitation
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH
The Gauteng Department of Health received a qualified report in 2008 on the control of sick
leave A performance audit was conducted by the Public Service Commission (PSC) (2002
xvi) into the information required to effectively manage sick leave in the public service
1
The research on absenteeism in Gauteng Department of Health seeks to examine the extent
of workplace absenteeism in the ODI District Hospital which is in a transitional stage from
North West to the Gauteng Province The hospital falls under Tshwane Metropolitan
Municipality and is in Region C The Germiston Hospital falls under Ekurhuleni Metropolitan
Municipality in Region B TARA Moross Centre Hospital is in Region A under the
Johannesburg Metropolitan Municipality and George Mukhari Academic Hospital is Region C
under the Tshwane Metropolitan Municipality The research seeks to examine the degree of
compliance by the four hospitals with the recommendations of the performance audit of
management of sick leave in the light of the qualified report received by the Gauteng
Department of Health (Human Resources) in 20089
13 PROBLEM STATEMENT
The Gauteng Department of Health provides health care services as the core business of the
Department The Health care services are labour intensive and high levels of absenteeism by
its employees undermine the Departmental efforts to deliver quality health care to the
people of Gauteng The problem statement therefore is to examine to what extent the
effective management of absenteeism can enhance the effectiveness of the Gauteng
Department of Health
14 AIM AND OBJECTIVES OF THE RESEARCH
The aim and objectives of the research are explained in this section
141 AIM
The aim of the research is to determine how the effective management of absenteeism can
contribute to the effective health care of Gautengrsquos communities
142 Objectives
The objectives of the study are
to determine the impact of the variables such as age gender occupational category
and salary level on workplace absenteeism
to determine whether the correlation between absenteeism levels and tenure of
service does exist
to determine trends of workplace absenteeism in different employee categories and
to establish the different challenges confronting the different hospitals in
management and control of absenteeism in terms of size complexity and location
2
15 LITERATURE REVIEW
Various studies have been conducted to examine workplace absenteeism in different fields
in government and private institutions Van Der Westhuizen (200636) research focused on
high and low combinations of job involvement and organisational commitment The
outcome was not emphatic on the findings as predictors of the turnover and absenteeism
The research noted that women are more absent from the workplace than men De Wit
(2006) focused on the nature of absenteeism the impact of absenteeism on the
organisation reasons for and causes of absenteeism and measurement of absenteeism and
the findings were not able to find a high coefficient in the test sample
Camp and Lambert (20054) found that the use of sick leave as an incentive to reduce sick
leave by the employees under the Civil Service Retirement System (CSRS) led to a reduction
of absenteeism as a result of sick leave when compared with employees who functioned
under the conditions of the Federal Employees Retirement System (FERS) who within the
same company lost the unused sick leave when they retired
Ferguson Ferguson Muedder and Fitzgerald (200138) focused on the impact of
absenteeism and cost in terms of time lost in the Total Absence Management (TAM)
concept and found that the aging employee exposes institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods of
time
Serneels Lindelow and Lievens (2008210) claim absenteeism is high among employees in
the public sector in developing countries due to a lack of accountability and a lack of
punishment for transgression
The research seeks to determine the extent of the problem of workplace absenteeism its
impact and management in the identified hospitals It seeks to establish the relationship if
any between the various variables and absenteeism such as age occupation tenure salary
level gender and race
16 TERMINOLOGY
Key concepts that are used in the research are conceptually defined however a
comprehensive concept clarification will be done in chapter 2
Workplace absenteeism Workplace absenteeism is the absence of employee at the
workplace that is defined by Du Toit and Van Der Waldt in (1998139) as the place that the
institution makes available and where officials have to perform their work
3
Workplace forms part of the internal environment for public administration in the public
service Robbins Odendaal and Roodt (200415) define absenteeism as the failure of an
employee to report for work as scheduled regardless of the reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work According to
Venter (2003267) desertion occurs when the employee leaves the place of employment
without the intention to return to work
Employee An employee is defined as any person employed in terms of the Public Service
Act 1994 irrespective of rank or position (Public Service Act 1994 Subsection 15) Todd
(20011) refers to an employee as any person excluding an independent contractor who
works for another person and is entitled to be paid for it or who in any manner assists in
carrying on or conduct the business of the employer Bendix (2000123) defines an
employee as a person in a workplace except a ldquosenior managerial employeerdquo whose status
and contract of service grants the employee the authority to represent the employer in
interactions with the workplace forum to determine policy on behalf of the employer and
make decisions which might conflict with representation of workers at the workplace
Employer An employer as an individual person who may be the employer in legal terms as
well as the organisation which is responsible for implementing Public Service human
resource management policies (RSA 1997 Section 15)
Leave cycle The Public Service Act 1994 refers to the leave cycle as 36 months employment
with the same employer
Quality Is defined as getting the best results possible within the available resources (RSA
2011)
Standard Is a statement of an expected level of quality delivery A standard reflects the
ideal performance level of a health establishment in providing quality care (RSA 2011)
17 RESEARCH DESIGN AND METHODOLOGY
This section deals with the research design and methodology
171 Research design
Research design is the overall plan for relating the conceptual problem to relevant empirical
research It is a quantitative descriptive research that involves the systematic collection of
numerical information under conditions of considerable control (Polit amp Hungler 1994
24175)
4
The choice of the research design influences subsequent research activities such as
identifying the target subjects what data to collect and how they should be collected The
research design is a descriptive stratified random survey which is concerned with
characteristics of a specific population subject at a fixed point in time for comparative
purposes The focus is on a representative sample of the relevant population It is concerned
with the accuracy of the findings and their generalisability The survey is used to gain deeper
insight of the behaviour of employees with regards to motivation satisfaction and
grievances (Babbie 199289 Ghauri Gronhaug amp Kristianslund 199527 60 Brink 199611
6 Welman Kruger amp Mitchell 200152)
172 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services Four hospitals of the thirty four health care delivery institutions have been
identified for the research
Each hospital is unique in its character in terms of specialisation of health care delivery
service The four hospitals are located in Tshwane Johannesburg and Ekurhuleni
Metropolitan Municipalities The sample is a stratified random sampling which is composed
of various clearly recognisable non-overlapping sub-populations (strata) that differ from
one another mutually in terms of variables that are a combination of more than one
variable such as age sex income level or educational level The purpose is to ensure that
every part of the population (every stratum) is represented The members of a particular
stratum are homogeneous in the population at large The sample is representative of a
population with clearly distinguishable strata with a greater degree of certainty (Babbie
199267 Brynard amp Hanekom 200544 Ghauri et al 199578 Brink 1996138 Welman amp
Kruger 200155-56 Welman et al 201061 Polit and Hungler 199518) The data were
collected in three phases
The first phase of data collection was done through auditing of hard copies of identified
personnel files representing ten files per hospital and using the tool in annexure A amp B The
forty employeesrsquo profiles were accessed through the Human Resource Information
Management system (HRIM) located in the Gauteng Department of Health Head Office The
respective employeesrsquo profiles were handed over to the human resource manager in the
respective hospitals on the morning of the audit for the human resource practitioner to
draw out the hard copy files for auditing The characteristics of the individuals that were
identified for the first phase were males and females and the different race groups The
auditing of the files was for the complete working life of the employees and not confined to
2008 only Registers that are used by the human resource administration to control the
movement of the leave forms were inspected as evidence of the control system in place
5
The purpose of auditing the files is to gain insight into how leave in general was captured
managed and controlled by the hospitals The second phase of data collection was done
through structured interviews with the four human resource managers who were directly
accountable for management and control of leave of absence in general in the four
hospitals
A structured interview provides for a more organised approach and a more stable basis for
assessment of the different candidates (Erasmus Swanepoel Schenk Van der Westhuizen amp
Wessels 2005250) The structured interview was conducted using the tool in annexure C
Tara Moross Centre Hospital had been functioning without a manager in human resource
and the manager that was interviewed had been in the post for three months The human
resource practitioner who was at salary level 8 acting in the Assistant Directorrsquos post
(manager) was invited to join the manager and be part of the structured interview ODI
District Hospital had three human resource practitioners including the accounting officer at
level 8 and in an acting capacity
The third phase of data collection was through the Human Resource Information
Management (HRIM) This system used Personnel Remuneration Administration System
(PERSAL) to collect data Data in this system are categorised in salary level date of
appointment occupational category gender age in units of five race employing hospital
employment status in different categories such as session contract and full-time and the
different types of leave of absence
The research used primary and secondary data in analysing sick leave utilised by full time
employees in the identified hospitals for the period of 1 January to 31 December 2008 using
the Personnel Remuneration Administration System The total population sample was four
thousands and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range at level 1 to 12
The research used past events such as sick leave utilised by employees using secondary
data from Personnel Remuneration Administration System falling into the category of a
historical empirical research The interval scale of measurement was used in the
quantitative research and actual numbers are ordered with equal measurement between
each category (Brink 1996 149 Brynard amp Hanekom 2005 28-29 Mouton 2005
52100170)
6
173 Unit of analysis
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the research refers to observation of work attendance by
the employees of Gauteng Department of Health in the four hospitals
The observation deals with the historical events such as employees who have already
utilised sick leave in the workplace The subjects that are studied are the core health care
providers such as doctors nurses and support employees such as allied administration and
administration support (Mouton 200551-52 Welman et al 2001 52-53)
174 Unit of observations
The observations that are made are of health care workers and support teams in Tara
Hospital Germiston Hospital ODI Hospital and George Mukhari Hospitals The unit of
observations describes the characteristics of a large number of individual people such as
gender age salary range occupational category tenure of service and race in relation to
absenteeism in the workplace In the descriptive research the individual characteristics are
aggregated for the purpose of describing a larger group (Babbie 199292)
18 CONSTRUCT VALIDITY
Construct validity is concerned with the question what construct is the instrument actually
measuring(Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with the four accounting officers in leave management The third phase was collecting of
personnel data through the Persal system
19 ETHICAL CONSIDERATIONS
Ethical considerations included among other issues the protection of the unit of analysis and
unit of observations from discomfort and harm by not revealing information which can
cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity Anonymity is achieved
when the researcher cannot link a given response with a given respondent and reporting
aggregate data only When data are collected at one sitting and not over a period of time
makes it possible to achieve anonymity as the need for follow up is eliminated Subjects of
observations are selected for reasons directly related to the problem being studied as the
principle of justice
7
Confidentiality is about the researcherrsquos responsibility to protect all data gathered within
the scope of the research and shared only with people involved in the research (Babbie
1992465ndash466 Brink 199640ndash41 45)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous The interview was part of the actual audit
that was done as part of monitoring and evaluation that was in progress in the Department
of Health following a negative auditor generalrsquos report about management of leave in
general The managers were put at ease as they were given the check list afterwards for
self-monitoring for future self-auditing
The data that were collected through Personnel Remuneration Administration System
(Persal) identified employees through the Persal number and kept their identity anonymous
The data that were collected through the hard copy of employeesrsquo files were used to point
out areas of concern to the managers and the files did not leave the office of the manager
at the end of the process once more protecting the identity of the employee
110 LIMITATIONS OF THE RESEARCH
The research was conducted on four hospitals of different sizes specialisation and three
metropolitans with unique challenges The period of the research was confined to a
calendar year (2008) and not a financial year The focus was on absenteeism due to sick
leave of full time employees There is no distinction that is drawn between the working-man
days that are lost between shift and non-shift workers The findings may be different if all
absenteeism of employees at the time were considered for the research
111 STRUCTURE OF THE RESEARCH
Chapter 1 It provides a general introduction to the research It includes an introduction the
background and motivation for the research that provides the context the problem
statement and the significance of the research The key concepts are defined The research
design the method of data collection the sampling method data analysis and
interpretation limitations to the research are explained in this chapter
Chapter 2 This chapter considers the theoretical foundations concepts characteristics
theories approaches and classifications of workplace absenteeism Conceptual framework
of absenteeism predictors of absenteeism and various models of absenteeism are
explained Measures to control workplace absenteeism the impact of absenteeism in the
institution and management intervention strategies are explained
Chapter 3 It describes the research design different aspects of the research methods
applied and the data collection techniques used unit of analysis units of observations
construct validity and ethical considerations
8
Chapter 4 This chapter provides the organisational structure of the Gauteng Department of
Health comparisons of hospital employees different race groups of the four hospitals
gender comparisons in different hospitals and comparisons of the different occupational
groups It provides a short description of the target hospitals The research interpretation is
discussed in terms of the different occupational groups and absenteeism different races
and absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism
The week days absenteeism pattern and contributions by the four hospitals to absenteeism
are presented in this chapter
Chapter 5 It provides a discussion of the research evaluation of workplace absenteeism
findings recommendations and limitations
112 REFERENCE TECHNIQUE
The reference technique that is applied in the research involves all sources that have been
consulted while doing the research When legislation is used as a source of information
reference to the specific act is used
113 CONCLUSION
Chapter 1 provides a discussion on the background and motivation of the research problem
statement and the objectives The significance of the research in South African public
institutions and private institutions of other countries and the possible contribution of the
study are explored The terminology that is used in the research is contextualised for the
purpose of the research The research design and methodology are presented in this
chapter The units of analysis the units of observation construct validity ethical
considerations and limitations to the research are also presented in this chapter
The next chapter discusses the theories of absenteeism
9
CHAPTER 2
MANAGING ABSENTEEISM
21 INTRODUCTION
The Gauteng Department of Health is classified as a public institution whose existence is
justified on the grounds that it renders health care services to the public The health care
system is encouraged to develop delivery systems and practices that are in line with
international standards management practices that promote efficient and compassionate
delivery of services and ensures respect for human rights and accountability to the public
(African National Congress 199443-44) This objective can only be achieved if the resources
to provide such services are available The human resources are a vital factor for the health
care sector as it is labour intensive Public institutions such as the Gauteng Department of
Health are funded from public funds and if the human resources do not report for work
service delivery is compromised and the cost to the department in the form of salary
expenditure becomes exorbitant as the department must find replacement staff and pay
for overtime as well It is when all these factors are taken into consideration that workplace
absenteeism becomes a cause for concern for the Gauteng Department of Health
In this chapter absenteeism is discussed from a theoretical perspective and informed by
literature review The classification of workplace absenteeism theoretical perspective
definitions dimensions of employment relationship conceptual framework of absenteeism
structural model of absenteeism legislative framework that regulates the employment
relationship and intervention strategies to control workplace absenteeism are explored
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM
According to Viviane (20111) the term absenteeism was first used in Britain during the
First World War in dealing with employed persons It is during the times when production is
of pressing national importance that the absence of employees from the workplace is keenly
felt Absenteeism is considered a good barometer of staff morale an indirect measure of
employeesrsquo health and well-being and is found to be associated with health-related
absences from work Employees who are motivated and committed to their work and
employer have to be very sick before they book off sick (Griep Rotenberg Chor Toivanen amp
Landsbergis 2010179)
McCormick and Ilgen (198556-57) describe job attendance criteria as relating to a tendency
of employees to withdraw from or attend to their jobs The criteria identified were job
tenure occupational category absenteeism and tardiness According to Markussen
Rogeberg and Gaure (20096) employee characteristics such as age gender education and
occupation have a substantial impact on absence behaviour
10
Chaudhury and Hammer (20033) identified that medical skills and nursing skills are
marketable and greatly in demand Doctors and nurses used this opportunity to make
money and work as private health care providers as well as public health care providers
holding two jobs The absence is considered in terms of morning or afternoon absence by
these categories as they are viewed as having a great deal of discretion over where and
when to discharge their public responsibilities The criteria identified were job tenure
absenteeism and tardiness
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) refer to absenteeism
as non-attendance when an employee is scheduled to work The theoretical perspective of
absenteeism takes into account the physical and or psychological absence of the employee
from the workplace or work station at a time when the employee is contractually expected
to be at the workplace According to Andrews (199734-35) the behaviour and actions of
public officials are determined by specific ethical codes of conduct and it is assumed that
their actions are for the benefit of the communities that are serviced by the public officials
Social ethics focus on how the clients of the Department are treated and are therefore
concerned with the impact of decisions on people inside and outside the institution
individually and collectively
Grogan (2005237) states that employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
look for trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
2001 section F(c) In the public sector contractual employee benefits are modified by
collective agreements These benefits are material gains for the employees and have a
monetary value and a cost factor to the employer
The contract of employment often includes insured benefits such as incapacity ill health
and early retirement as the total package other than the remuneration for the time worked
as it is intended to attract retain and motivate employees (Breetzke 20091 Ferguson et al
200137 LexisNexis 2006670 LexisNexis 2007176 Markussen Rogeberg amp Gaure 20093
Tustin 199452) The policy on Determination on Leave of Absence requires a medical
certificate for sick leave of three or more days and for every sick leave day utilised when the
eight week rule has been transgressed (DPSA 2009 Section 14 subsection 147)
Political ideologies influence the work environment resulting in some areas being highly
unionised where unions are perceived to be capable of exerting control over the employer
and employee relations for the primary benefit of the employees
11
It is the work environment which is highly unionised that is characterised by high workplace
absenteeism (Andrews 199736 Breetzke 20091 Du Toit amp Van Der Waldt 1998170139
Tustin 199452) Allen (1984331) claims that union members might be absent more
frequently from the workplace than non-members because they face smaller penalties for
absenteeism According to Markussen et al (20095 21) workplace environments do have an
impact on absenteeism and are influenced by social interaction processes among
colleagues Absenteeism is affected by social norms Workplaces with high employee
turnover rate tend to have high absenteeism The turnover rate is defined on a quarterly
basis as Min (number of entries number of existing persons) divided by the number of
employees at the start of the quarter The Charted Institute of Personnel and Development
(CIPD) (200811) claim that the 2006 survey of absence management portrays the public
sector employees as less likely to be dismissed for reasons of workplace absenteeism A
report by the National Institute of Labour Studies (Tonya 20011) found the rate of
absenteeism increased among full-time employees from 2 4 to 25 within two years
The services that are provided by the Department of Health are divided into two distinct
categories Direct services are those services that are rendered to the clients who are
patients who receive medical treatment from the core employees usually referred to as line
functionaries Direct services can only become effective and efficient when supported by
the services of the support staff that provide indirect health care services When employees
do not present themselves for work when scheduled to work and do so on a regular basis
the situation becomes habitual absenteeism (Du Toit amp Van Der Waldt 199818) The
Gauteng Department of Healthrsquos core function is to provide health care services to the
people of Gauteng Province The provision of health care services is labour intensive and
requires large numbers of personnel for effective service delivery
The workplace which may be physical or virtual for the public service employees represent
the internal environment of the institution The employer who is represented by the
manager determines the workplace for employees
Rogers and Hertin (1993217) explain the Decision Model Theory as a conscious decision by
the employee to stay away from work or come to work based on which motivation is
stronger at that moment It is not based on the ability to come to work
Serneels et al (2008210) claim that absenteeism is rife in the public sector especially where
employees hold two jobs The actions of public officials in the performance of their duties
should be ethically justified as it impacts on the decisions of people within and without the
institution individually and collectively Tension and job insecurity in the workplace
manifests as absenteeism (Andrews 199733-137)
12
Frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased staff
morale and high cost to health care (Davey amp Cummings 2009312-313) It is suggested that
on average health care workers are likely to be absent from work as a result of illness or
injury rather than other occupations Dagmara (20002) states that absenteeism may be a
benchmark of what is happening in the hospital setting Absenteeism is defined as habitually
not coming to work when scheduled to It is an indicator of psychological medical or social
adjustment to work
Absenteeism is measured by frequency or duration of work-days missed Frequency
measures provide a reasonable index of voluntary absenteeism whereby each incidence or
episode of absence is counted regardless of the duration of absence It is defined as the
number of days absent over a given period of time Other measures used were total days
duration and percentage Duration measures provide an index of involuntary absenteeism
such as time lost index To assess absence duration the total number of days is tallied
regardless of the number of incidents (Davey amp Cummings 2009313) High workload is
identified as one of the factors that affect absenteeism rate among health care workers
(Oi-ling 20023)
Workplace absenteeism is costly for an institution in terms of lost working-man days hiring
of staff to close the shortage absent or sub-standard service delivery and poor quality of
services The total cost of employment risk approach is about the estimation of the possible
cost of any absent employee to an institution per hour The annual cost to the institutions
per employee is in terms of direct and indirect costs such as overtime low productivity and
a decline in morale among workers who are expected to cover for an absent employee
(Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
The public service employees enjoy security of tenure which may be a contributory factor
of absence from work without good cause This practice is fostered by the knowledge that
they cannot be easily dismissed from their jobs therefore have the belief it is right to stay
away from work Misuse of sick leave is considered to be an overriding problem in instances
where the employee does not uphold the standard of honesty and incorruptibility or these
values are not considered to be the corporate values and norms of the institution (Andrews
1997 221-222 MINTRAC 20093)
Bangali (20043-5) describes age function in the sociological theory as a natural
characteristic of human beings but also an integral aspect belonging to the structure of the
society The age definition in the labour market is influenced by the structural functionalism
The employees age is categorised in the workplace in terms of functions to be performed
be it physical or intellectual The age group of 35 years to 49 years old employees comprise
the largest age group in the labour market
13
The employees who are less than 20 years of age reflect the highest absenteeism rate while
employees above 50 years of age reflect a decrease in the absenteeism rate The
disadvantage of the older workers is that their disabilities last longer once they are injured
and are more likely to be absent as frequently and more likely to be injured than younger
workers Keese (20062) states that ageism is evident in the public service and describes the
age group 25 years to 49 years old as prime age Rogers and Hertin (1993219) found a
significant correlation between the use of sick leave and age Employees with advanced age
used comparatively more sick leave in comparison with the younger employees The
Canadian Nurses Association (20065) noted a reduction in workplace absenteeism rate
among nurses who are less than 45 years of age and an increase in the absenteeism rate
among nurses above 55 years of age
Camp and Lambert (20054) found that the use of sick leave retention as an incentive to
reduce use of sick leave by the employees under the Civil Service Retirement System (CSRS)
leads to a reduction of absenteeism as a result of sick leave compared to the Federal
Employees Retirement System (FERS) who within the same company lost the unused sick
leave when they retired The Employees Retirement System (FERS) applies the same
principle of handling sick leave as the Gauteng Department of Health in the sense that
unused sick leave is forfeited at the end of the three year cycle (DPSA 2009Section 14)
Unruh and Strickland (2007674) found that absenteeism from the workplace does
contribute to a vicious cycle of a negative work environment which leads to more
absenteeism and increased turnover Absenteeism has been found to be higher in
employees who are over 50 years of age and the phenomenon is attributed to age and
changing abilities that increase when work is performed on a full time basis Part-time
arrangements reduce absenteeism as well as the cost of paying for a senior employee even
if seniority is just in tenure Age has been linked to a negative turnover in an institution The
older employee is less likely to leave the organisation An institution is healthier for a spread
of ages Some organisations consider employees to be older in batches or cohorts of five
such as 40 years to 44 years up to 64 years (Nichols amp Evangelisti 2001285 McGoldrick amp
Arrowsmith 200184 MINTRAC 20093 Reday-Mulvey 200579-194)
MINTRAC (20094-8) states that gender moderates the age turnover relationship Women
are more likely to remain in their jobs the older they get than men do Turnover is
occasionally related or preceded by high workplace absenteeism The occupational category
is linked to skill levels and salary levels The lower skill employees are concentrated in the
lower skill occupations and easily replaceable
14
Hirschfield Schmitt and Bedeian (2002553) conducted a research on low-wage public
sector clerical employees and found that those employees who perceived limited
performance-reward expectancies were likely to be absent more often The link between
skilled employees and absenteeism suggested that employees may have utilised
absenteeism as a means of compensating for perceived workplace contributions not
extrinsically rewarded
According to Gaudine and Gregory (2010599) the Canadian Institute for Health Information
(2007) found that absenteeism was a problem among health care workers in comparison to
other employees in other sectors Unruh et al (2007673) found the combination of high
registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery Markussen et al (200921) claim that the type of occupation an
employee is engaged in has an impact on absenteeism
221 Classification of absenteeism
The employees of the Gauteng province and their attendance at work are the focal point of
the province in relation to service delivery that is customer focused Health care services are
labour intensive and require employees to be at work when scheduled to do so (Gauteng
Province 201015) Workplace absenteeism can present in different forms and levels as a
result of a combination of variables (Andrews 19975 Breetzke 20091) McCormick and
Ilgen (198557) and Davey and Cummings (2009313) classify absenteeism as voluntary
when the absence is based on the conscious decision by the health care giver to withhold
contractual services The absence is uncertified unauthorised and unexcused while
involuntary absenteeism occurs for reasons beyond the control of the health care giver
such as illness injury or family responsibility Employers are challenged with the task of
differentiating between the absence due to elective workplace absence and absence due to
illness incapacity The differentiation is based on whether the illness incapacity is validated
by a legitimate medical certificate in terms of the prescript of section 23 of the Basic
Conditions of Employment Act (BCEA) 75 of 1997 (RSA 1997)
222 Definition of key concepts
Concepts are defined for common understanding in the context of the study
Workplace absenteeism Workplace absenteeism is absence of the employee at the
workplace that is defined by Du Toit and Van Der Waldt (1998139) as the place that the
institution makes available and where officials have to perform their work It forms part of
the internal environment for public administration in the public service Bamford Klein and
Engelbrecht (199911) refer to absenteeism as employees taking time off that has not been
scheduled
15
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) claim that
absenteeism is non-attendance when an employee is scheduled to work The European
Foundation (199711) views absenteeism as temporary or permanent incapacity for work as
a result of sickness or infirmity According to Robbins Odendaal amp Roodt (200415)
absenteeism is a failure of an employee to report for work as scheduled regardless of the
reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work The employee
should actually intimate expressly or by implication the intention not to return to work
According to Venter (2003267) desertion occurs when the employee leaves the place of
employment without the intention to return to work
Employee The Basic Conditions of Employment Act no 75 of 1997 Section 1 (a) (RSA 1997)
and Todd (20011) refers to an employee as any person excluding an independent
contractor who works for another person and is entitled to be paid for it or who in any
manner assists in carrying on or conduct the business of the employer The courts use the
control test which identified employees on the basis that they were part of the employer
organisation Bendix (2000123) claims that an employee is a person in a workplace except a
senior managerial employee whose status and contract of service grants the employee the
authority to represent the employer in interactions with the workplace forum to determine
policy on behalf of the employer and make decisions which might conflict with
representation of employees at the workplace Du Toit Bosch Woolfrey Godfrey Rossouw
Christie Cooper Giles and Bosch (200368) state that an employee is a person who works
for a single employer in a permanent fulltime capacity is subject to the supervision of the
employer and receives regular monthly or weekly remuneration and is obliged during
working hours to place his or her productive capacity at the employerrsquos prescribed disposal
Employer
Bendix (2000129) defines an employer as any person except an independent contractor
working for another person or the State and who receives remuneration or any manner
assists in carrying out or conducting the business of an employer DPSA (PILIR) (20094)
states that an employer is the Head of Department or a designated office which will be
responsible for the handling and investigation of incapacity leave applications and ill- health
retirement applications
16
23 EMPLOYMENT RELATIONSHIPS
The employment relationship is about balancing the simultaneous convergent and divergent
interests of the employer and the employee in a regulated manner with the aim of getting
the work of the institution done According to Erasmus et al (2005442) an employment
relationship exists when an individual is employed by someone else to be available to work
for that person in exchange for some remuneration It is through this employment
relationship that reciprocal rights and obligations are created between the employer and
the employee The employment relationship is conflictual in nature (Andrews 199736) The
employees through this relationship are enabled to gain access to the rights and benefits
associated with their employment The Labour Relations Act no 66 of 1995 (RSA 1995)
regulates the management of the conflict in the employment relationship through dispute
resolution structures such as the Commission for Conciliation Mediation and Arbitration
(CCMA) Labour Court and Labour Appeal Court when internal processes fail to resolve the
conflict The employment relationship can be traditional or typical and terms and conditions
of service of employment are regulated by collective agreements This is a tacit
acknowledgement of the existence of a typical employment relation
231 Employment relationship as a multi-dimensional phenomenon
Industrial relations and human resource management are bound together by the
employment relationship through labour employer and industrial relation triangle The
employment relationship is characterised by various dimensions as is the case in a broader
society The dimensions are economic legal individual collective and psycho-social (Grogan
200347)
2311 Economic dimensions
The economic dimension arises through the provision of labour by the employee in the form
of skill knowledge energy abilities and productive time to the employer in exchange for
remuneration Barker (200779) states that a reduction in working hours increases the
hourly cost of production in a unit unless there is a commensurate increase in productivity
The economic dimension is highly regulated The contract of employment includes insured
benefits such as incapacity ill health and early retirement The tendering of services by the
employees is a prerequisite to the employeersquos right to claim remuneration (Grogan
200347) According to LexisNexis (2007176) and the Public Service Regulations 2001
Section E E1 the actual contractual benefits are modified by collective agreements in the
public service sector Employee benefits are material gains for employees that have
monetary value and are a cost factor to the employer The Public Service Regulation 2001
Section F (a) states that the Head of Department shall promote economic and efficient use
of resource to improve the functioning of the public service (RSA 2001)
17
According to Ferguson et al (200137) and Erasmus et al (2005380) employee benefits are
the total compensation package other than the pay for time worked offered to employees
either partially or completely funded by the employer contributions In 2006 about R19
billion was lost on account of absenteeism from sick leave (LexisNexis 2006670 Patrick
2001 17)
Employee benefits are intended to attract retain and motivate employees Some of the
benefits offered to employees are mandated by law such as minimum leave provision as
contained in the Basic Conditions of Employment Act 75 of 1997 and Resolution 72000 of
the Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
2312 Legal dimension
The Labour Relations Act 66 of 1995 Section 3 of Schedule 8 requires that while employees
should be protected from arbitrary action employers are entitled to satisfactory conduct
and work performance from their employees The legal framework provides for the
regulatory requirements for human resource management in the working environment
Grogan (200347) and Grogan (2005120) view the employment relationship as formalised
by a legally binding agreement which is the contract The contract is regulated by specific
laws and formal rules with all the inherent rights and responsibilities to the employer and
the employee In terms of the employment contract one of the responsibilities of the
employee is to render service to the employer at specified agreed upon time except where
the employer has authorised the absence of the employee from the workplace Employees
have a fundamental duty to render services and the employer has a right to expect the
employees to tender such services A basic element of the duty to render service is that the
employee must be at the workplace at the specified agreed upon times unless there is
adequate reason to be absent Bendix (2000120) states that a contract is subject to the
terms and conditions of collective agreements The contract is subject to automatic changes
whenever a new collective agreement is in place The contract and its inherent benefits are
breached by elective absence behaviour of the employee The legal dimension has an
impact on the individual dimension
2313 Individual dimension
The employee enters into a working contract with the employer on an individual basis The
contents of the contract are subject to the Basic Conditions of the Employment Act 75 of
1997 The terms and conditions of employment in the public service are subject to collective
bargaining and collective agreements which influence the employment contract in the
Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
18
The contract of employment is entered into between the employer and the employee under
the supervision of the employer and for remuneration purposes
2314 Collective dimension
According to Slabbert and Swanepoel (20017) the collective dimension of the employment
relationship refers to the organised group aspect of the employment relationship which is
between labour as a group and employers and or their representative public sector
institutions The collective dimension aspect of employment relationship pertains to
legislation relating to bargaining dispute resolution and industrial action
2315 Psycho-social dimension
The psycho-social dimension of the employment relationship represents the unexpressed
needs and expectations of the employer and employees It refers to behaviour in the public
sector institutions within the context of the collective dimension (Davey amp Cumming 2009
313 Erasmus et al (2005442) The Public Service Regulation 2001 Section B states that the
Head of Department shall determine the working time of employees and take into
consideration their personal circumstances which have a social dimension (RSA 2001)
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM
Davey and Cummings (2009322) amalgamated two theories to create a theoretical
framework with the premise that employee attendance is based on two factors the ability
to attend and motivation to attend The theoretical framework focuses on individual work
ethics demographics and from the work environment Some form of absenteeism may be
difficult to prove in a situation where the employer has two or more operational stations or
the employee occasionally operates from a virtual office The duty to render service is
breached by the employee when the employee is physically present and mentally absent as
would be the case of sleeping on duty Workplace absenteeism is multi-dimensional such as
changes in the work environment that overburden the coping mechanism As a result of this
approach a multi-dimensional framework of absenteeism clouds the causative factors of
absenteeism (Breetzke 20091 Patrick 200124 Tustin 199452)
19
FIGURE 21 CONCEPTUAL FRAMEWORK MODEL
(Adapted from Davey amp Cummings 2009320)
The conceptual model uses individual predictors of absenteeism such as age salary level
tenure race gender occupation educational level job satisfaction and organisational
commitment ability to attend and pressure to attend Organisational commitment is
described as having loyalty to the organisation identifying with its core values and
influences whether or not an employee feels it is appropriate to take unauthorised
unscheduled absences Group level absenteeism is not viewed as a predictor of individual
absenteeism (Davey amp Cummings 2009320 Lambert Camp Edward amp Saylor 20058-9)
25 PREDICTORS OF ABSENTEEISM
Oi-ling (20023-6) claims that in Hong Kong there were 47500 work days lost as a result of
employee sick leave in 1998 and suggests the examining of stress levels for nurses in
different cultures to enable a fuller understanding of the predictors of absenteeism as
different cultures accept some predictors and some reject the same reasons for illness
20
Personal characteristics
2Employee value Job
expectation
1Job situation scopejob level role
stress work amp group size leadership
style
4 Satisfaction
with job situation
3 Ability to attend Illness and accidents transport problems
6 Attendance motivation
7 Employee
attendance
5 Pressure to attend work
incentiveswork ethics
Education
salary
tenure age
gender race
Occupation
Lambert et al (20058) claim that organisational commitment job satisfaction job stress
health issues and personal characteristics correlate as regards employee absenteeism The
findings of the research by Van Der Westhuizen (2006136) focused on high and low
combination of job involvement and organisational commitment and the outcome was
emphatic on the turnover as predictor of absenteeism
According to Unruh and Strickland (2007674) absenteeism from the workplace contributes
to a vicious cycle of a negative work environment which leads to more absenteeism and
increased turnover McCormick and Ilgen (198556) describe turnover as dysfunctional
where an employee wishes to leave the institution and the employer prefers to retain the
individual and is functional where the employee wishes to leave the institution and the
employer accepts the termination of services by the employee
De Wit (2006) focused on attitudes towards job factors that had an influence on
absenteeism and was not able to find a high coefficient in the test sample McGoldrick and
Arrowsmith (20018) claim that an organisation is healthier for a spread of ages Ferguson et
al (200138) state that aging employees expose organisations to high levels of absenteeism
through higher probabilities of becoming disabled for longer periods
Oi-ling (20023-6) and Patrick (200124) found that gender and age among other predictors
of absenteeism have a significant influence on absenteeism Age was positively related to
well-being in managers and negatively related to absence frequency among hospital
employees Older employees were shown to have higher responsibility at work and utilised
minimal days for sick leave Female employees were observed to have utilised more
absences than males
Andrews (1997221-222) and MINTRAC (20093-8) state that gender moderates the age
turnover relationship Women are more likely to remain in their jobs the older they get than
men do Turnover is occasionally related or preceded by high workplace absenteeism The
occupational category is linked to skill levels and salary levels The lower skill employees are
concentrated in the lower skill occupations and easily replaceable Public service employees
enjoy security of tenure which maybe a contributory cause of absence from work without
good cause a practice that is encouraged by the knowledge that they cannot be easily
dismissed from their jobs therefore have the belief it is right to stay away from work
Rogers and Hertin (1993217-222) found a correlation between the use of sick leave and
age Employees with advanced age comparatively used more sick leave in comparison with
younger employees The level of education seems to have influenced the use of sick leave
where the lower level categories of employees were found to have a higher level of
absenteeism than higher educated individuals
21
Robbins et al (200447) state that married women employees have fewer absences and
undergo fewer job turnovers Rogers and Hertin (1993222) express tenure as work
experience in years that is viewed as a predictor of employee productivity where seniority
has been found to be inversely related to absenteeism in terms of frequency and total
number of work-man days lost The level of education was found to have an influence
where the lower category of employees was found to have higher levels of absenteeism
than higher educated employees Jacobs and Roodt (2011425) and Davey and Cummings
(2009320) state that an organisational culture in hospitals can contribute towards lower
turnover as the turnover rate is a predictor of absenteeism The process can be facilitated
by promoting knowledge sharing that can provide opportunities that may meet employee
expectations
Pousette and Hanse (2002229-231) suggest that theories that make predictions about
antecedents to ill health and sickness absence make the assumption that the relationships
are the same in different occupations Reduced job autonomy is suggested to be associated
with higher sickness absence The occupation specific model is used in order to identify the
variance in the patterns in terms of occupation-groups Davey and Cummings (2009320)
found that turnover was significantly related to absenteeism
Hirschfield et al (2002553) conducted a research on low-wage public sector clerical
employees and found that those employees who perceived limited performance-reward
expectancies were likely to be absent more often The link between skilled employees and
absenteeism suggested that employees may have utilised absenteeism as a means of
compensating for perceived workplace contributions not extrinsically rewarded Unruh et al
(2007674) found that absenteeism from the workplace does contribute to a vicious cycle of
a negative work environment which leads to more absenteeism and increased turnover
26 A MULTI-GROUP INVARIANCE MODEL
A multi-group invariance structural model represents different types of occupations such as
industrial blue-collar workers industrial collar workers elderly care workers and child
health care workers The focus of this model relates to the extent to which a model that is
assumed to include a general population also includes sub-populations such as different
occupational types The occupation specific model allows different relationships between
variables in different occupations The specific model approach allows for identification of
the most common reasons for absenteeism and early retirement in the workplace and was
successfully utilised in Sweden A common model proposes that absenteeism is a
behavioural response to dissatisfaction with the job (Pousette amp Hanse 2002230-244)
Nyathi (200059) found that professional nurses were absent from work because they
wanted to prolong their weekends
22
Davey and Cummings (2009313) argue that on average health care employees are more
likely to be absent from work as a result of illness or injury than other occupations Paton
(20104) acknowledges that line managers are the fundamental building blocks for reducing
absenteeism and must be provided with the tools to manage absence The absence rate at
3 is considered very high and must be vigorously and progressively managed
FIGURE 22 MODEL SPECIFICATION
(Adapted from Pousette amp Hanse 2002232)
Pousette and Hanse (2002232-245) make the assumption that low job autonomy and low
skill discretion deprive the employees of the opportunity to handle work obstacles and
regulate workload to a manageable level implying a negative relationship to workload has
an impact on absenteeism rate Patrick (200123-24) states that changes in the working
conditions overburden the coping mechanism Work-related stress can lead to deteriorating
physical and emotional well-being The work object is the distinguishing quality between
occupations in the different occupational groups whereby the blue-collar employee works
with things that are tangible such as materials and machines whereas the white-collar
employee is knowledge based employee who is working with data
23
Structural Model
W L Work load
I H Ill-Health
S A Sickness absenteeism
S D Skills discretion
(autonomy)
27 CATASTROPHIC MODEL (CAT)
According to Buschak Craven and Ledman (199628) the catastrophic model (CAT) caters for
major illness that keeps the employee away from work for extended periods of time This
model is similar to short and long term incapacity sick leave whereby the employee has
exhausted the normal sick leave of 36 days which is catered for by DPSA section 14 (RSA
2009)
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM
The general behaviour and actions of public officials are determined by specific ethical
codes of conduct and the unethical conduct results in effective administration and
unsatisfactory service delivery (Andrews 199733) Effective control of workplace
absenteeism requires an absenteeism policy to be in place management to establish the
magnitude and patterns of absenteeism and raise awareness about the consequences of
breaking these rules (Bamford Klein amp Engelbrecht 19992)
The Determination on Leave of Absence in the Public Service (DPSA 2009 section 14 141)
the Public Service Co-ordinating Bargaining Council Resolution (PSCBC 72000) Davey and
Cummings (2009313) and DPSA (PILIR) 2009 section 3 31 state that an employee is
entitled to 36 working days sick leave with full pay in a three year cycle with the same
employer Any unused leave credits shall lapse at the end of the three year cycle The
employee is expected to utilise and manage the normal leave circumspectly The employee
who chooses to utilise sick leave days must submit a medical certificate for every occasion
of three or more sick leave days utilised The medical certificate must be issued and signed
by a practitioner or persons who are registered with the Professional Councils established
by the Act of Parliament Incapacity leave is additional sick leave granted conditionally at the
employerrsquos discretion An employee who has exhausted the normal sick leave during the
prescribed sick leave cycle and who requires to be absent from work due to a temporary
incapacity may apply for temporary incapacity leave with full pay According to the Policy
and Procedures on Incapacity Leave for Ill-Health Retirement (PILIR) (DPSA 2009) an
employer is not required to pay an employee if the employee has been absent from work
for more than two consecutive days or more than two occasions during an eight week
period and on request does not produce a medical certificate
The Public Service Regulations 2001 F (c) holds the manager accountable when an
employee abuses sick leave (RSA 2001) According to Parbhoo (20036) and Nel et al
(2008145) the doctor patient confidentiality is not above reach to the employment
relationship by suggesting that the employer can question the authenticity or contents of
the medical certificate if there is sufficient reason to do so within the confines of
confidentiality
24
According to Breetzke (20092) South African employees are challenged by global trends to
seek mechanisms to deal with excessive absenteeism at the workplace The Charted
Institute of Personnel and Development (CIPD) (200811) claims that the 2006 survey
showed that public sector employees are less likely to be disciplined or dismissed for
reasons of workplace absenteeism
281 Measuring absenteeism
Measuring absenteeism in the workplace enables the employer to determine the extent and
nature of the problem Absenteeism is measured using two measures total time lost and
absence frequency Nel et al (2001584) In institutions total time lost is determined for
every group of employees and category of absence such as sick absence authorised and
unauthorised absence The recognised international norm is 3 Institutions challenged
whether to accept the international norm as the given or strive to bring workplace
absenteeism down in the interest of quality and quantity of service delivery The total time
lost index is calculated as the Total number of days lost due to absence over the period
multiplied by a thousand and divided by the average number of employees multiplied by a
thousand and divided by an average number of employees multiplied by total work-days
over the period (Amin Das amp Goldstein 20086 Breetzke 20094 Nel et al (2001584)
According to Nel et al (2001584) high workplace absenteeism rate is suggestive of incidence
that is of short duration and therefore more disruptive to the operational plans of an
institution as prior knowledge of pending workplace absenteeism allows for forward
planning and reduction of the costs associated with absenteeism The absence frequency
rate is calculated as Number of absence incidence over the period divided by the average
number of employees employed over the period (Breetzke 20094 Nel et al 2001254)
29 IMPACT OF WORKPLACE ABSENTEEISM
Lambert et al (20056 36) claim that absenteeism has adverse effects on those employees
who are good attenders as they are shuffled around to fill in the positions of absent
employees Organisations suffer the detrimental effects and consequences of employee
absenteeism Management expend valuable time to modify employee assignments to
respond to absences When employees who are in management or in highly specialised job
assignments report sick the work assigned to them remains undone because their positions
remain vacated and the work remains for them to complete The responsibility and
accountability these employees are entrusted with may influence less use of sick leave by
them
The White Paper on Transforming Public Service Delivery (DPSA 1997) holds management
responsible for the specific level of resources and for obtaining value for money in these
resources
25
Madibana (201022) found in the research about absenteeism amongst nurses that the high
rate of absence had an impact in the reduction of quality care rendered by nurses
291 Cost to the institution
Andrews (19978221) describes an institution as the process through which activities are
grouped logically into the distinct areas and assigned to managers It results in the logical
grouping of activities in a department Workplace absenteeism influences the cost of an
institution which influences the quality of the product or service that is rendered by the
institution Employee attendance is a vital element for managing productivity of any
institution and its individual members The unfilled posts reflect the absence of public
health care employees and do not absorb budget resources for salary and upkeep of
facilities Absent personnel still receive their salaries If public servants are not on the job
the expenditures embodied in them do not reach their beneficiaries (Chaudhury amp Hammer
20032 Lambert et al 20055) The cost is direct in terms of salary expenditure or indirect in
terms of staff replacement
Ferguson et al (200138) argue that the cost of employment risk approach is about
estimation of the possible cost of any absent employee to an institution per hour per day
Robbins Odendaal and Roodt (200415) estimate that absenteeism costs South African
institutions millions of rand a year in decreased efficiency and increased benefit payments
Fakie (20053) notes that sick leave costs the national government 15 of the total basic
salary expenditure for the National Department of Health from 1 January 2001 to December
31 2003
The South African Chamber of Business (SACOB) (Patrick 200117) acknowledges that in
2006 about R19 billion were lost on account of absenteeism resulting from sick leave
According to the European Foundation (19977) United Kingdom lost 11 billion pounds in
1994 Germany lost 30 5 billion EUC in 1993 and Belgium lost 24 billion EUC in 1995
Breetzke (20092) describes indirect costs as hidden costs harder to measure and may
include economic value of lost productivity Indirect costs relate to loss of production that
may arise by engaging some expects to provide service in the field where they are closing
the staff shortage gap Rogers and Hertin (19939) and the European Foundation (19978)
view the individual employee and his or her dependants in a social dimension aspect as
exposed to reduced income as a result of extended workplace absenteeism related to ill
health where long term incapacity is involved
The total cost of employment risk approach is about estimation of the possible cost of any
absent employee to an institution per hour The cost may be direct and indirect such as
overtime low productivity and a decline in morale among workers who are expected to
cover for an absent employee (Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
26
292 Low productivity
According to Jankowitz (19911) high levels of absenteeism are disruptive to production
where operators are interdependent or where levels of service have to be maintained
Buschak Craven and Ledman (199626) argue that absenteeism generates costs for the
institution and productivity problems put an unreasonable burden on the rest of the
employees who are at work An absent employee be it physical or psychological remains an
unproductive employee Absenteeism viewed from an employerrsquos perspective is regarded as
a problem that impacts negatively on service delivery while the employeesrsquo believe their
mere presence in the workplace is being productive
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM
Managing workplace absenteeism remains a challenge for all employers and the Gauteng
Department of Health has not been spared the challenges faced by other institutions as it
provides health care services to the citizens of Gauteng The provision of good quality health
care is vital for the development of human capital The implications of declining quantity
and quality of care is grave when the human capital equity and efficiency which are the
cornerstones of health care service delivery are threatened by employees who are not at
work when expected to be (Gauteng Province 200711) Misuse of sick leave is considered to
be an overriding problem in instances where the employee does not uphold the standard of
honesty and incorruptibility or these values are not considered to be the corporate values of
the institution (Andrews 1997 221-222 MINTRAC 20093)
According to Grogan (2005237) employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
identify trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
Part V Section F(c) (RSA 2001) The workplace can be a virtual office Workplace
absenteeism is perceived to be high in unionised workplace environments where unions are
perceived to be capable of exerting control over the employer and employee relations for
the primary benefit of the employees In the public sector contractual employee benefits
are modified by collective agreements
Public service managers are to focus towards results achievement and be accountable for
the performance of their institutions (Gauteng Province 201023) Workplace absenteeism
can be reduced by tightening up policies and procedures relating to control of absenteeism
and intensifying monitoring processes on absent employees
27
According to Cloete (2004290-297) public institutions are to provide quality goods and
services The public institutions require an appropriate infrastructure to enable them to
perform their core functions (Bamford et al 19991 Buschak et al 1996 28 Munro
200722)
2101 Effective communication
According to Oi-ling (200212) managers should alter the psycho-social environment at work
and cultivate an institutional climate that supports staff and facilitate effective
communication Institutions should raise awareness to employees of their rights and
responsibilities regarding leave of absence and the consequences of abusing it (Bamford et
al 19992) The policies should be clearly written and well communicated to all employees
and be readily available and accessible In a highly unionised environment these policies are
debated in bilateral or multi-lateral forums between management or employer
representatives and labour representatives The human resource practitioners must conduct
periodic in-house training on these policies for management and employees to facilitate
uniform interpretation and enforce compliance by all stakeholders The policies must be
couched in simple understandable language that is free of legal terms for ease of
comprehension by all users The policies on workplace absenteeism must be explicit of
actions to be taken when policies have been violated or employees are aggrieved
2102 Empowerment of managers
Workplace absenteeism is multi-dimensional requiring inputs from all related fields
Managers require on-going support and training on issues that relate to absenteeism at the
workplace The human resource unit works with managers to establish performance
standards training of employees on the importance of execution and assists managers to
focus on continuous improvements superior execution and employee empowerment
(Bergdahl 20019 RSA 2011)
The labour relations unit supports the training of managers on grievance handling bilateral
and multi-lateral encounters with employee representatives with employee education
issues specific to workplace absenteeism The Charted Institute of Personnel and
Development (CIPD) (200835) reported that 70 of managers in the public service have
been trained in workplace absenteeism handling
Employment relationships bind human resource and industrial relations together with the
common objective of achieving institutional goals and labour peace Managers focus on
managing the institution for productivity at the lowest possible cost by providing quality
care therefore reducing the risk of litigation control of absence from work and work
efficiency
28
It is the delays in dealing with issues that give the employees the feeling of being unfairly
treated and demoralised Consistency in upholding these processes is essential for creation
of a stable employment relationship while any deviation from the set processes give rise to
worker unfriendly environment (Bergdahl 20118-9)
2103 Monitoring of workplace absenteeism
The manager is expected to keep accurate records for all leave of absence taken by
employees In terms of the management of ill-health absencersquos the manager has to ensure
that the eight week rule is observed whereby the employee who has been absent from
work on more than two occasions during an eight- week period must regardless of the
duration of the sickness or injury submit a medical certificate (RSA Part V section F (b)
DPSA 2009 section 14 148) Pierce (200921) believes that management of human capital
may be achieved through the integration of employee benefits employee assistance
programmes and human capital
Monitoring of absenteeism is a human resource function that gets lost in the competing
functions that are carried out by human resource practitioners High levels of absenteeism
are an indication of poor management and or conflict within the employment relationship
The methods to monitor workplace absenteeism vary from one institution to the other It is
human resource management that establishes common guidelines that are used by
management to monitor workplace absenteeism In monitoring absenteeism the manager
considers each employeersquos case on its merit
The manager focuses on certain aspects of the case such as failure to call in on the day of
absence pattern of use of sick leave before or after holidays and sick absence occurring on
certain days of the week or month Monitoring systems to monitor and record attendance
of work are put in place to assist management with simple accurate functional data that
facilitates informed decision- taking at management level The employees of the province
and their attendance at work become the focal point of the province in relation to service
delivery Peer pressure monitoring comes from colleagues at the same facility Hierarchical
monitoring of employees by management may lead to more attendance for fear of being
discovered (Chaudhury amp Hammer 200319 Gauteng Province 201015) A health care
service institution may use Health Information System and Personnel and Salary
Administration System (PERSAL) among others to ease the burden of the monitoring
process All these tools combined are useful in gathering administrative data for
management
29
2104 Visits to facilities
The role of human resource at institutional level is to support and guide management as
well as monitor compliance issues Workplace absenteeism remains a key focus area
because of its impact on the budget of an organisation Unscheduled facility visits are
conducted with the view to audit workplace absenteeism The audit is to be done in line
with the auditor-general or internal risk managementrsquos approach to encourage consistency
A check list that is used is prepared by human resource practitioners and institutions are
familiar with A human resource accounting officer of the institution should be involved
when an audit is done
The institution must have evidence available of sporadic visits to employees who have been
identified as having developed absenteeism patterns with the view to rule out elective
absence The European Foundation (199713) and Munro (200722) state that ill- health is
the main reason for workplace absenteeism Employees who present with ill- health are
generally and frequently more absent from work than the healthy ones The authors also
observe that not all employee assistance programmes aimed at reducing workplace
absenteeism have an effect on the ill-health of the employees which render the
unscheduled visit to the employees vital to see where the caring employer could be of
assistance
2105 Incentive system
According to Buschak et al (199628) the catastrophic model (CAT) caters for major illness
that keeps the employee away from work for extended periods of time This model is similar
to short and long term incapacity sick leave which is catered for by PILIR subsection 73
(DPSA 2009) The managers require special training for successful implementation of the
policy The paid time off model (PTO) has hidden benefits incentives for employees not to
use unnecessary sick days which are then paid for at retirement The research by Lambert
and Camp (20054) compares the Civil Service Retirement System (CSRS) and the Federal
Employees Retirement System (FERS) and showed that in the final analysis and when
novelty wore off workplace absenteeism was not necessarily reduced by the incentive
system
Management should use the strategy to raise awareness about responsible utilisation of sick
leave through workshops about PILIR and the eight week rule It should show the benefits
of good sick leave management when employees are challenged with temporary or
permanent incapacity leave
The use it or lose it approach of the current system reward the abuse of sick leave as it is
viewed as not being beneficial by the employees to act responsible towards the use of sick
leave There is no deterrent not to abuse sick leave in the public sector
30
2106 Team support
Institutions value team effort over individual achievement Operational competencies are
viewed as essential Managers encourage effective communication among team members
motivating others and the development of problem-solving skills Managers through the
team development effort encourage nurturing and transmitting of the institutional culture
Institutional culture refers to a system of shared meaning within an organisation that
determines how employees behave in the workplace Culture and people are like glue that
ensures that institutional standards are upheld Individuals become units that form the
team and conversations at work are encouraged to strengthen team work knowledge
transfer and productivity (Bergdahl 20018-10 Goldsmith amp Morgan 200378 Robbins amp
Decenzo 2001174)
2107 Return-to-work interviews
According to Paton (20101ndash5) a phased return-to-work data management and remote
services are among the approaches employers may use to manage workplace absenteeism
The intervention can involve use of Information Technology systems and telephone
discussions Good absence management is about good people management The return-to-
work interviews provide management with the opportunity to get to know the employee
better and for the employee to substantiate his or her case The employee is afforded
privacy during the sessions which should happen as soon as the employee comes back to
work The key success in this strategy is unthreatening follow ups that are done A multi-
faceted approach is used to get people back to work such as phoning maintaining regular
contact and taking medical advice
The Charted Institute of Personnel Development Annual Report (200835) reported 90 of
public services that use the strategy and 77 use the risk assessment to aid return- to-
work The manager should have private counselling sessions with the employee as soon as
the employee returns to work These sessions provide the employee with the opportunity to
put his or her case across and for the employer to get a first-hand opportunity to asses if the
employee is fit enough to come back to work The employer has to make the employee
aware of the status of the meeting that it is formal and proceedings are recorded The
employer is to keep accurate records of all counselling sessions
31
2108 Employee assistance programme (EAP)
DPSA (PILIR2009) prescribes that the PILIR committee promotes EAP in the workplace and
each institution to establish a committee The PILIR committee consists of a labour relations
officer an EAP practitioner a health practitioner an employee wellness practitioner and
any other relevant practitioner who is co-opted on a needs basis The purpose of the
committee is to manage short and long term incapacity which is sick leave utilised after the
employee has exhausted the 36 days normal sick leave in a three year cycle The short term
incapacity sick leave is of longer than three days and less than 29 days and long term
incapacity is sick leave longer than 29 days The short spells of sick leave become a concern
when there is evidence of a pattern of abuse It is a call for the manager to intervene Every
organisation should provide EAP that is funded by the employer to the employees A health
risk manager is used by the employees who are expected to honour referrals and stay with
the programme until such time that there is evidence of recovery failure by the employee
to accept the programme should attract a disciplinary process
According to Mellor Arnold and Gelade (20098) the amount of support that followers
receive from their transformational leader or co-worker may help reduce levels of absence
by making the workplace a more pleasant place to be and perhaps by helping the person
find solutions to work out family conflict or other problems that produce absence Landstad
et al (20011) suggest that the individuals in the preventive intervention group who were
less than 42 years of age total absence due to sickness decreased The change was obvious
to the cleaners who had a previous history of high absence due to sickness The Charted
Institute of Personnel Development (200836) focused on working-man days lost
management of absenteeism employee well-being and employee rehabilitation The skilled
employees were reported as 12 who were using rehabilitation programmes Yende
(200535) and Fakie (200517) state that EAP despite having been around since 1996 for the
National Department of Health has not actually been managed and utilised to its full extent
whereby if fully utilised would assist in the management of employee workplace
absenteeism
2109 Occupational and safety committee
The focus of this committee is on the provision of a safe working environment by the
employer (RSA Part VI section D 2001) It monitors issues of compliance and adopts the
employee advocacy role The committee consists of all the major stakeholders such as
employee representatives labour representatives that represent employees in the
institution on issues of safety at the workplace In the context of the Gauteng Department
of Health the committee engages with the labour representatives and employer
representatives at bilateral and provincial multi-lateral scheduled meetings
32
According to Du Toit and Van Der Waldt (1998139) the International Labour Organisation
recommends creation and maintaining of a pleasant work environment in order to improve
productivity The environment must stimulate the employee to ensure efficiency and
effectiveness
21010 Review committee
This structure is essential when dealing with incapacity leave It is composed of
management human resource practitioner employee representative labour relations
officer employee wellness and any adhoc person needed in terms of the case under
discussion (DPSA PILIR 2009) The employee reserves the right to lodge a grievance about
the outcome of his incapacity request if it is negative The role of the committee is to
provide a transparent forum reduce hostility against management and to protect the rights
of the employee through involvement of the employee representative
211 CONCLUSION
The literature review that has been consulted explores the workplace absenteeism and its
impact on the institution The employment relationships represent a triangle that consists of
the employer the employee and the industrial environment The relationship is multi-
dimensional and highly regulated with built in mechanisms to handle conflict in the
workplace Conflict is inherent to the employment relationship and structures and
mechanisms such as bargaining councils the Commission for Conciliation Mediation and
Arbitration and Labour Courts are structures for recourse The theory of absenteeism and
employment relationship were explored Management intervention strategies were
explained Controlling absenteeism in the workplace begins with a sound absenteeism
policy that is incorporated into an employee induction programme Communicating and
educating the employees about the absenteeism policy takes the centre stage in the
employment relationship Vigilant monitoring of workplace absenteeism is the responsibility
of the manager closest to the employee such as the supervisor Workplace attendance
problems of employees can be handled using sound judgement keeping accurate
attendance records and administering the policy fairly and consistently
Chapter 3 will collect data which will confirm or negate the literature review that has been
explored in chapter 2
33
CHAPTER 3
METHODOLOGY OF THE RESEARCH
31 INTRODUCTION
Chapter 3 focuses on the methodology used to determine the absenteeism in the four
hospitals of the Gauteng Department of Health The research design and the methodology
that have been used to collect data are discussed below The data are collected in terms of
the characteristics of the stratified random sample such as absenteeism of the different
occupational categories gender age tenure of service race groups and salary
32 RESEARCH DESIGN
A research design is the overall plan for relating the conceptual problem to relevant
empirical research It is a quantitative descriptive research that involves the systematic
collection of numerical information under conditions of considerable control The choice of
the research design influences subsequent research activities such as identifying the target
subjects what data to collect and how they should be collected The research design is a
descriptive survey which is concerned with characteristics of a specific population subject at
a fixed point in time for comparative purposes The focus is on a representative sample of
the relevant population It is concerned with the accuracy of the findings and their
generalisability The survey is used to understand the behaviour of employees with regards
to motivation satisfaction and grievances (Babbie 1992 89 Ghauri et al 199527 60 Brink
199611 Welman et al 200152)
321 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services The four hospitals that have been targeted for the study of absenteeism are Tara
Moross Centre Hospital in Region A under the Johannesburg Metropolitan Municipality
Germiston Regional Hospital which is in Region B under Ekurhuleni Metropolitan
Municipality ODI District Hospital in Region C under Tshwane Metropolitan Municipality
and George Mukhari Academic Hospital in Region C under Tshwane Metropolitan
Municipality Each hospital is unique in its character in terms of specialisation of health care
delivery service The sample is a stratified random sampling which is composed of various
clearly recognisable non-overlapping sub-populations (strata) that differ from one another
in terms of variables that are a combination of more than one variable such as age sex
income level or educational level The purpose is to ensure that every part of the population
(every stratum) is represented The members of a particular stratum are homogeneous with
the population at large
34
The sample is representative of a population with clearly distinguishable strata with a
greater degree of certainty (Babbie 19927 Brink 1996138 Brynard amp Hanekom 2005 44
Ghauri et al 199578 Welman amp Kruger 200155-56 Polit amp Hungler 199518)
The data were collected in three phases The first phase of data collection was done through
auditing of hard copies of identified personnel files encomprising ten files per hospital and
using the tools in annexure A and B The forty employeesrsquo profiles were accessed through
the Human Resource Information System (HRIM) located in the Gauteng Department of
Health Head Office The respective employeesrsquo profiles were handed over to the human
resource manager in the respective hospital on the morning of the audit for the human
resource practitioner to draw out the hard copy files for auditing The characteristics of the
individuals that were identified for the first phase were males and females as well as
representatives from the different race groups The auditing of the files were for the
complete working life of the employees and not only confined to 2008 calendar year
Registers that are used by human resource administration to control the movement of the
leave form were inspected as evidence of the control system in place The purpose of
auditing the files was to gain insight into how leave in general was captured managed and
controlled by the hospitals
The second phase of data collection were done through structured interviews with four
human resource managers who were directly accountable for management and control of
leave of absence in general in the four hospitals A structured interview provides for a more
organised approach and a more stable basis for assessment of the different candidates
(Erasmus et al 2005250) The structured interview was conducted using the tool in
annexure C Tara Moross Centre Hospital had been functioning without a human resource
manager and the manager that was interviewed had been in the post for three months The
human resource practitioner who was at salary level 8 and acting in the Assistant Directorrsquos
post (manager level 9) was invited to join the manager and be part of the structured
interview ODI District Hospital had three human resource practitioners including the
accounting officer at level 8 in an acting capacity The third phase of data collection was
through the Human Resource Information Management System (HRIM) This system uses
the Personnel Remuneration Administration System (PERSAL) to collect data Data in this
system is categorised in characteristics such as salary level date of appointment
occupational category gender age in units of five race employing hospital employment
status in different sub-categories such as session contract and full-time and the different
types of leave of absence The continuous sick leave of four to five days was excluded from
processing and focus was laid on sporadic days to the start and end of a weekend
35
The research used secondary data in analysing sick leave utilised by full time employees in
the identified hospitals for the period of 1 January to 31 December of 2008 using Persal The
total population sample was four thousand and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range from level 1 to
12 The research used past events such as sick leave utilised by employees using secondary
data from Persal falling into the category of historical empirical study The interval scale of
measurement was used in the quantitative research and actual numbers are ordered with
equal measurement between each category (Brink 1996 149 Brynard amp Hanekom 200528-
29 Mouton 200552100170)
33 UNIT OF ANALYSIS
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the study refers to observation of work attendance by the
employees of Gauteng Department of Health in the four hospitals The observation deals
with the historical events as employees have already utilised the sick leave in the workplace
The subjects that are studied are the core health care providers such as doctors nurses and
support employees such as allied administration and administration support (Mouton 2005
51-52 Welman et al 2001 52-53)
34 UNIT OF OBSERVATIONS
The observations that are made are of health care employees and support teams in Tara
Moross Centre Hospital Germiston Hospital ODI Hospital and George Mukhari Hospital
and describe the characteristics of a large number of individual people such as sex age
salary range occupational category tenure of service and race in relation to absenteeism in
the workplace The descriptive study and the individual characteristics are aggregated for
the purpose of describing a larger group (Babbie 199292)
35 CONSTRUCT VALIDITY
Construct validity is concerned with the question What construct is the instrument actually
measuring (Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with four of the accounting officers in the leave managements The third phase was
collecting of personnel data through the Persal system
36
36 ETHICAL CONSIDERATIONS
Ethical considerations will include amongst other issues such as the protection of the units
of analysis and units of observations from discomfort and harm by not revealing
information which can cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity
Anonymity is achieved when the researcher cannot link a given response with a given
respondent and reporting aggregate data only When data are collected at one sitting and
not over a period of time makes it possible to achieve anonymity as the need for follow up is
eliminated Subjects of observations are selected for reasons directly related to the problem
being studied as the principle of justice Confidentiality is about the researcherrsquos
responsibility to protect all data gathered within the scope of the study and shared only
with people involved in the research (Babbie 1992465ndash466 Brink 199640ndash41 45 Polit amp
Hungler 1995 31-36)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous to the researcher The interview was part
of the actual audit that was done as part of monitoring and evaluation that was in progress
in the Department of Health following a negative auditor generalrsquos report about
management of leave in general The managers were put at ease as they were given the
checklist afterwards for self-monitoring and for future self-auditing
The data that were collected through Persal identified employees through the Persal
number and kept their identities anonymous The data that were collected through the hard
copy of employeesrsquo files were used to point out areas of concern to the managers and the
files did not leave the office of the manager at the end of the process once more protecting
the identity of the employee
37 CONCLUSION
This chapter dealt with the research design which is the overall plan for relating the
conceptual problem to relevant empirical research The methodology used a stratified
random sample which is composed of various clearly recognisable non-overlapping sub-
populations that differ from one another in terms of variables that are a combination of
more than one variable The data collection was done through three phases The unit of
analysis refers to the persons who are studied The unit of observations are health care
workers and support teams in the four identified hospitals The construct validity used a
multi-trait multi-method approach Ethical considerations include among other issues
protection of the unit of analysis and the unit of observations from discomfort and harm
Chapter 4 discusses the analysis and interpretation of the data gathered in chapter 3
37
CHAPTER 4
INTERPRETATION AND ANALYSIS OF DATA
41 INTRODUCTION
This chapter focuses on the research analysis and interpretation of data gathered on
workplace absenteeism in the Department of Health of the Gauteng Province It seeks to
identify differences or similarities in the leave trends in the 2008 calendar year between the
four identified hospitals chosen for the study in the Municipality of Tshwane Ekurhuleni and
Johannesburg The year 2008 was chosen as a second year in the leave cycle that started in
2007 The type of leave of absence is interpreted as a collective that does not specify the
type of sickness or illness or it being acute or chronic Workplace absenteeism is absence of
the employee at the workplace that is defined by Du Toit and Van Der Waldt (1998139) as
the place that the institution makes available and where officials have to perform their
work It forms part of the internal environment for public administration in the public
service Direct public administration is directly concerned with the rendering of services to
the citizens of the country
Chapter 4 discusses the study of workplace absenteeism in the four identified institutions
namely Tara Moross Centre Hospital Germiston Hospital ODI District Hospital and George
Mukhari Hospital In this research the following factors will be examined the organisational
structure and absenteeism of the different workforce categories such as medical and
nursing professionals administrative staff allied professionals and various categories of the
general assistants workforce and their relation to absenteeism in the institution
42 THE STRUCTURE OF THE ORGANISATION
The Gauteng Province is one of the nine provinces of South Africa In 2005 the auditor-
general conducted an audit of sick leave performance in six national departments and the
Gauteng Province was among those that were omitted from the audit The research focuses
on the Gauteng Department of Health (GDoH) whose core function is to provide health care
services to the people of Gauteng The provision of health care services is labour intensive
and requires large numbers of personnel for effective service delivery The GDoH is serviced
by thirty-four hospitals four of which have been identified for the study of management of
sick leave The employee attendance to work is essential to the achievements of the
Departmental goals The Determination on Leave of Absence determines the leave policy for
public service employees (DPSA 2009) The employees of GDoH represent the staff
component as reflected in the organisational structure of the department
38
The Gauteng Department of Health (GDoH) provides the basic health services to the people
of Gauteng who as internal or out-patients are clients or consumers of the services referred
to as line functions Public administration services rely heavily on support services such as
the personnel department that renders support to line functions that provide the actual
service of patient care Support services are considered as indirect public administration
services and essential in efficient public service delivery Workplace absenteeism has a
negative impact on productivity Employees of the Gauteng Department of Health and their
attendance to work are the focal point of the Province in terms of effective health care
service delivery that is customer focused
Political ideologies as those espoused by labour representatives are part of the external
factors in the workplace environment that consequently have an impact on public
administration and management and workplace attendance by employees (Du Toit amp Van
Der Waldt 1998139170)
FIGURE 41 INTERGRATED ORGANISATIONAL STRUCTURE
(Adapted from Gauteng Department of Health organisational structure 2010)
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY
The Gauteng Provincial Government has made a commitment to its people to account for
the delivery of services as its electoral mandate This commitment will be achieved only
when monitoring and evaluation of its performance is enforced by all Gauteng Department
of Health service providers
39
MEC
HOD
COP
Senior Exec
CD HAST CD Health program
Senior Exc
CD Tshwane
CD JHBWest
CFO
Manage Account
SENIOR CORPORATE
HRM amp LR
GenderampDisability
The Gauteng Governmentrsquos commitment to provision of health care services to all its
citizens is demonstrated by the decentralisation of management of service delivery with the
view to foster accountability increase efficiency and accountability (ANC 199419ndash20
Goldstein 200815) The interpretation of the analysed data takes the sector performance
approach into consideration when the interpretation of absence is across all the
occupational groups for the 2008 calendar year (Gauteng Province 201015)
44 COMPARISON OF HOSPITALSPERMANENT EMPLOYEES
Gauteng employees are counted at 51475 from the Personnel Salary Administration System
(PERSAL) as of March 2008 The population from the four chosen hospitals has been
counted at 4010 reflecting 8 of the total population The different groups of employees
were identified as Africans represented as n=3902 Whites as n=51 Indians as n=14 and
Coloureds as n=43
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALS
(Source Compiled by the researcher C S Ndhlovu 2012)
Figure 42 reflects the racial split percentage of the workforce (n=4010) of the hospitals
The population from the four hospitals has been counted as 4010 reflecting 8 (n=51475)
of the total working population for Gauteng Department of Health as from 1 January to 31
December 2008 The different groups of employees were identified as Africans represented
by 973 (n=3902) Whites as 13 (n=51) Indians as 03 (n=14) and Coloureds as 11
(n=43) The George Mukhari Hospital has a female dominated workforce at 739 (n= 2097)
in a total workforce of n=2836
40
Population n=4010
Africans 973
Whites 13
Coloureds 11
Indians 03
TABLE 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALS
RACE TARA HOSPITAL GERMISTON GEORGE
MUKHARI
ODI TOTAL
Africans 227 367 2836 472 3902
Whites 23 24 3 1 51
Coloureds 5 37 0 1 43
Indians 13 1 0 0 14
Population 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 1 focuses on the distribution of race and the population of the total workforce The
geographical area of the hospital determines the demographics and the tendency of some
groups being poorly represented or totally absent The research focused on permanent
employees of the four hospitals The George Mukhari Hospital employees are reflected as
7079 (n=2839) ODI Hospital as 1182 (n=474) Germiston Hospital as 1069 (n=429)
and Tara Moross Centre Hospital as 668 (n=268) of the total working population Tara
Moross Centre and Germiston Hospitals are located in cosmopolitan areas while the George
Mukhari and the ODI Hospitals are in rural and semirural areas The positioning of the latter
hospitals may account for the high African workforce
41
TABLE 2 COMPARISONS OF NUMBERS OF ADMINISTRATION AND SUPPORT STAFF IN THE
DIFFERENT HOSPITALS
OCCUPATIONAL
GROUP
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Administration
staff
48 60 297 61 466
Administration
support
103 140 719 133 1095
TOTAL 151 200 1016 194 1561
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 2 presents the administration employees and the administration support in the four
hospitals Tara Moross Centre Hospital is represented by 3179 (n=151) of administration
and 6822 (n=103) administration support The George Mukhari Hospital has the highest
representation by the administration support at 7077 (n=1016) The high representation
of the administration support staff at George Mukhari Hospital could be partly because of
the semi-rural environment A semi-rural environment is usually characterised by poverty
which may have a negative influence on opportunities to access education and skills
Doctors and nurses are highly marketable because of the educational levels and skills that
are lucrative and enable this group to be highly mobile geographically (Chaudhury amp
Hammer 20033)
42
TABLE 3 GENDER COMPARISON IN DIFFERENT HOSPITALS
GROUPS HOSPITALS MALE FEMALE POPULATION
Africans Tara 83 144 227
Germiston 52 315 367
George Mukhari 739 2097 2836
ODI 109 363 472
TOTAL 983 2919 3902
Whites Tara 5 18 23
Germiston 5 19 24
George Mukhari 3 0 3
ODI 1 0 1
TOTAL 14 37 51
Indians Tara 1 12 13
Germiston 0 1 1
George Mukhari 0 0 0
ODI 0 0 0
TOTAL 1 13 14
Coloureds Tara 1 4 5
Germiston 6 31 37
George Mukhari 0 0 0
ODI 1 0 1
TOTAL
GRAND TOTAL
8
1006
35
3004
43
4010
(Source Compiled by C S Ndhlovu 2012)
Table 3 focuses on gender distribution in the population of the research represented by
males and females in the different racial groups
43
The geographical area of the hospital determines the demographics and the tendency of
some groups being poorly represented or totally absent The males of the different hospitals
account for 251 (n=1006) while the females account for 749 (n=3004)
The George Mukhari Hospital has a female dominated workforce at 7394 (n=2097) out of
a total workforce of n=2836 White male employees are represented by 011 (n=3) against
the total workforce of the hospital (n=2839) There are no Indians and nor any Coloured
employees African males are represented by 2603 (n=739) The same hospital has no
white female employees no Indians no Coloureds and 7395 (n=2097) African females
The table reflects a predominantly African female workforce The hospital is situated in a
rural setting and this may have an impact on the vast difference in the gender
representation
The Tara Moross Centre and Germiston Hospitals are located in cosmopolitan areas They
have 187 (n=5) and 1117 (n=5) White male employees respectively and 672 (n=18)
and 443 (n=19) female employees respectively Tara Moross Centre Hospital has 4 48
(n=12) female Indian employees while Germiston Hospital has only 024 (n=1) Germiston
Hospital has 723 (n=31) female Coloured employees while Tara Moross Centre has 150
(n=4) The core function of the various hospitals may have influenced the gender
distribution
TABLE 4 COMPARISON OF TENURE OF SERVICE IN RELATION TO ABSENTEEISM IN THE
FOUR HOSPITALS
TENURE IN YEARS DAYS OF ABSENCE PERCENTAGE
1ndash10 4451 30
11ndash20 6577 443
21ndash30 2934 198
31ndash40 878 59
TOTAL 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 4 reflects the level of tenure of the total workforce from 1 year to 40 years of service
Tenure of 11 years to 20 years of service reflects 443 (n=6577) utilisation of leave of
absence and remains the highest rate of absenteeism followed by tenure of 1 to 10 years of
service at a 30 absenteeism rate
44
TABLE 5 COMPARISON OF THE OCCUPATIONAL GROUPS IN THE DIFFERENT HOSPITALS
OCCUPATIONAL
CATEGORIES
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Doctors 12 12 354 19 397
Professional
nurse
47 81 548 109 785
Staff nurse 15 53 358 56 482
Nurse assistant 16 50 308 55 429
Social worker 4 4 8 3 19
Occupational
therapists
4 0 15 1 20
Radiographer 0 3 27 6 36
Clinical
Psychologists
4 0 10 2 16
Physiotherapists 0 1 9 1 11
Dieticians 0 0 5 3 8
Finance 4 11 59 9 83
Speech
therapists
0 0 5 1 6
Pharmacists 2 9 36 5 52
Dentists 0 0 0 3 3
Technicians 2 5 51 6 64
Librarian 1 0 0 0 1
Security 6 0 30 1 37
Administration
and support
151 200 1016 194 1561
TOTAL 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 5 reflects a great difference in terms of number of occupational groups in the four
hospitals
45
The core function and the size of the hospital seems to have a bearing on how many
occupational categories of employees are to be found in that hospital as well as the actual
figures of these categories The George Mukhari Hospital is an academic hospital that trains
medical doctors This hospital has 1247 (n=354) doctors in a staff establishment of
n=2839 Tara Moross Centre has 448 (n=12) in a staff establishment of n=268 Germiston
has 280 (n=12) in a staff establishment of n=429 and ODI District hospital has 401
(n=19) in a staff establishment of n=474 This trend of vast differences in figures
represented by the occupational groups is evident in the category of professional nurses
where George Mukhari Hospital reflects 1931 (n= 548) nurses Tara Moross Centre is
represented by 1754 (n=47) Germiston by 1889 (n=81) and ODI District hospital by
23 (n=109) The impact of absenteeism is pronounced when viewed against the level of
facility capacity in terms of human resources of the core occupational groups
441 The Tara Moross Centre Hospital
Tara Moross Centre Hospital is a speciality psychiatric hospital in Region A with a workforce
of 669 (n=268) of the total workforce (n=4010) The core function of the hospital is
specialised such that some occupational categories are not available in the hospital as part
of the workforce and patients are referred out to other facilities for specialised treatment
Tara Moross Centre Hospital falls under the jurisdiction of the Johannesburg Metropolitan
Municipality
442 The Germiston Hospital
Germiston Hospital is a regional general hospital in Region B with a total permanent staff
establishment of 1070 (n= 429) of the total workforce (n=4010) The hospital falls under
the Ekurhuleni Metropolitan Municipality It does not have occupational therapists clinical
psychologists dieticians speech therapists and dentists in its permanent staff
443 The ODI District Hospital
The ODI District Hospital is in Region C and is in transition due to boundary changes It is
being transferred from the North West Province to the Gauteng Province The hospital is in
a semi-rural area with a staff component of 118 (n=474) of full-time employees (n=4010)
and falls under Tshwane Metropolitan Municipality It is a general district hospital
444 The George Mukhari Hospital
The George Mukhari Hospital is an academic hospital in Region C under Tshwane
Metropolitan Municipality The hospital trains doctors and employs 010 (n=3) White male
employees 26 (n=739) African males and7184 (n=2097) African females out of the
total female workforce (n=2919)
46
This phenomenon may be as a result of the hospital having the highest general assistants
workforce at 2065 (n=586) out of the workforce (n=2839) The George Mukhari Hospital
has the highest number of general assistants out of the four hospitals represented as 25
(n=719) in a total workforce of n=2836 African employees
45 RESEARCH INTERPRETATION
The interpretation of leave of absence is confined to salary level 1 to 12 full time employees
of the Gauteng Department of Health who took leave of absence from the workplace for the
calendar year in 2008 It excludes the contract employees periodic remuneration foreign
employees and permanent employees above salary range 13
The Basic Conditions of Employment Act 75 of 1997 Section 9 (3) (RSA 1997) prescribes
procedures in terms of progressive reduction of the maximum working hours to the goal of
a 40-hour working week and an eight-hour working day Finnemore and Van Rensburg
(2002462) state that the reduction of maximum working hours to 40 hours a week is done
through collective bargaining with due regard to job creation efficiency and health safety
and welfare of employees Du Toit and Van Der Waldt (1998232) use the formula to
aggregate lost working-man hours due to ill health and disability as aggregate lost hours in
the survey period divided by 40 hours in a week and x number of hours in a year A formula
to work out the absenteeism rate by Pierce (2009) is represented as A=BC A= Absenteeism
rate B= Total number of days lost due to absenteeism in a given period C= Total number of
working- man days available in the given period C=D x E D=Total number of employees
planned to work in the given period E=Number of available working days in the given
period
The approach of the research uses the principle of absence from the workplace when due to
work to identify the lost working hours (Pierce 2009 Davey amp Cummings 2009313) The
study applies a retrospective approach
The working-man lost days for the Province in the four hospitals is approached in terms of
lost working -man days simplified refers to the number of days meant to have been worked
but actually not worked due to illness or disability by the employees in a year divided by the
total number of employees of the public sector (PXVI) Barker (200779) argues that a
reduction in working hours increases the hourly cost of production and unit production
unless there is a commensurate increase in productivity This approach has a similar effect
on workplace absenteeism when the workload of those employees who are present
increases as they carry the double load to meet the demands of service delivery The cost of
absence to the Province is expressed as salary expenditure for each day of leave of absence
from the workplace (PSC 2002 xiii Pierce 2009)
47
The salary range is laid down according to Annexure in DPSA Circular 1 of 2008 The Gauteng
Government experienced a cost estimated at R29 million in 2000 and approximately R54
million in 2001 from absenteeism and loss of working time (Parbhoo20031)
The formula that is used in this research to calculate lost man work-hours is collective
working days of absence multiplied by 8 hours in a working day resulting in the total
working hours that are lost This formula can be represented as
Lost days x hours (8) in a working day = lost working hours
As stipulated by the Basic Conditions of Employment Act 75 of 1997 section 9 1(c) 3
TABLE 6 RACES IN RELATION TO ABSENTEEISM
RACE TOTAL DAYS OF ABSENTEEISM PERCENTAGE
Africans 14295 963
Whites 242 16
Coloureds 201 14
Indians 102 07
TOTALS 14840 100
(Source Compiled by the researcher 2012)
Table 6 represents absenteeism in the diverse races in the workplace The absenteeism rate
seems to be proportional to the number of employees The Employment Equity Act 55 of
1998 defines the term ldquoblackrdquo as a generic term which means Africans Coloureds and
Indians The Africans as a race group is represented by 963 (n=14295) of the total
working days lost (n=14840) The high figure of lost working-man days reflects the
demographics of the four hospitals The George Mukhari Hospital is in a rural setting that is
predominantly African populated and employs the highest number of Africans as
represented in table 3 Whites are presented by 16 and not represented in all
occupational categories and salary ranges that could explain the low figures and
percentages associated with working-man days lost Africans constitute the highest number
of employees as well as the highest percentage of working-man days lost Absenteeism
percentage is proportional to the employment figures for this race group The Indian race
group is represented by the lowest figure of employment and lowest percentage of leave of
absence which is proportional to the employment figure
48
TABLE 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM
OCCUPATIONAL
GROUPS
TARA GERMISTON ODI GEORGE
MUKHARI
TOTALS
DOCTORS 22 118 5 290 435
PROFESSIONAL NURSE 272 346 20 2459 3097
STAFF NURSE 128 247 13 1568 1956
NURSE-ASSISTANT 150 126 25 1145 1446
FINANCE 0 0 0 386 386
ADMINISTRATION 57 272 20 1923 2272
ADMIN SUPPORT 754 547 163 3784 5248
TOTAL 1383 1656 246 11555 14840
(Source Compiled by C S Ndhlovu 2012)
Table 7 reflects the working-man days lost by the different occupational groups The
doctorsrsquo workload in terms of the annual report for Gauteng Department of Health
(2008951) was 226 as against the target of 227 while the national target was 187
The bed occupancy rate target for the same time was 75 while the actual figure was
653 The annual report interpreted in conjunction with the data of leave of absence for
doctors reflects a negative impact in terms of service delivery and the cost factor to the
department
451 Occupational groups in relation to absenteeism
The multi-group invariance structural model presents different types of occupations and is
used to identify variance in the patterns in terms of occupational groups The model allows
different relationships between variables in different occupations The different
occupational groups are doctors professional nurses and sub-categories administration
staff and administration support staff (Pousette amp Hanse 2002230) According to Gaudine
and Gregory (2010599) absenteeism was a problem among health care workers in
comparison to other employees in other sectors The cornerstone of an efficient health care
service delivery is equity and efficiency which is threatened when employees are not at
work when expected to be (Andrews 199734-35 DPSA 1997)
49
According to the Charted Institute of Personnel Development (200811) the survey that was
conducted found that public sector employees are less likely to be disciplined or dismissed
for reasons of workplace absenteeism
Tables 5 and 6 and 7 reflect the different occupational groups and the level of absenteeism
in the four hospitals of the Gauteng Department of Health
4511 Doctors
Doctors are represented by 10 (n=397) of the total working population (n=4010) The
29 (n=435) indicates the number of working-man days lost in relation to the total
working- man days lost (n=14840) The percentage of working- man days lost in relation to
the total number of full time employees of the four hospitals is reflected as 435 divided by
n=4010 times the percentage which results in 108 (n=435) working-man days lost
multiplied by 8 hours that represent a working day The outcome is n=3480 working-man
hours The cost to the Province is calculated in terms of the salary expenditure as direct and
indirect salary payment for lost working-man hours estimated at 3480 hours at salary level
10 at R217 482 to salary level 12 at R 407745 as well as indirect costs such as replacement
of staff and overtime
The doctorsrsquo workload in terms of Gauteng Province 20089 annual report (2008951)
reflects the doctorrsquos workload as 226 as against the target of 227 while the national
target is reflected as 187 The bed occupancy rate target for the same time is 75 while
the actual target rate is 653 The annual report when interpreted in conjunction with the
data of leave of absence for doctors reflects a negative impact in terms of service delivery
and the cost factor to the Department when considering a loss of n=3480 man hours of
work
Chaudhury and Hammer (200311) found in their research that the doctors presented the
highest absenteeism rate Serneels et al (2008210) argue that absenteeism is rife in the
public sector where employees hold two jobs and is highest among doctors The doctor
absenteeism rate in the research does not stand out as high in comparison with the other
occupational groups The doctor absenteeism rate is 29 when compared to the total
workforce This occupational group is represented by 10 of the total population The
doctorsrsquo absenteeism rate does not seem to be outstandingly high in comparison with the
other occupational groups in relation to the total number of permanent doctors
50
4512 Professional nurses
The professional nursesrsquo absenteeism is reflected as 208 (n=3088) that indicates the
number of working-man days lost in relation to the total working-man days lost (n=14840)
The percentage of working-man days lost in relation to the total number of full time
employees (n=4010) in the four hospitals is reflected as 77 The cost to the Province
translates into direct and indirect salary expenditure which is spread from salary level 4 to
12 at R64 410 to R407 745 in 2008 for the total duration of lost working days
Du Toit and Van Der Waldt (1998232) pointed out a crisis in four other public hospitals in
the Gauteng Province that was caused by budget cuts and shortage of doctors and nurses in
2008 The vacancy rate of 697 in the professional nurse category and the absence rate of
208 in 2008 in the four hospitals seem to point to a lack of adequate human resources for
effective health care delivery The extent of working-man hours lost in the findings of the
research suggest a high rate of absenteeism and not a good reflection of happiness as
suggested in the annual report Professional nurses are second to the administration
support in absenteeism at 208 at a total of (n=785) nurses in the four hospitals with
absenteeism of n=3088 working-man days lost or n=20704 working-man hours lost This
category of employees is classified as skilled to highly skilled at salary range of 4 to 12The
total vacancy rate was at 697 as against the national target at 15 in 2008 with
absenteeism of 208 Madibana (201022) found in the research about absenteeism
among nurses that the high rate of absence had a negative impact in the quality of health
care rendered by nurses
4513 Staff nurses
Staff nurses are reflected in tables 4 and 5 as representing 12 (n=482) of the total working
population (n=4010) The 132 (n=1956) indicates the number of working-man days lost
in relation to the total working-man days lost (n=14840) times the percentage
The percentage of working-man days lost in relation to the total number of full time
employees in the four hospitals is reflected as 488 The cost to the Department is
expressed as direct and indirect salary expenditure for n=15648 working-man hours lost
The impact of leave of absence to health care services and cost to the Department is the
same as the professional nurses as staff nurses are a sub-category of the nursing profession
4514 Nursing assistants
Nursing assistants are reflected in tables 4 and 5 as represented by 107 (n=429) of the
total working population (n=4010) and 97 (n=1446) represent working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The
percentage of working-man days lost is reflected as 36 (n=1446) in relation to the total
number of employees in the four hospitals (n=4010)
51
The cost of leave of absence to the Department is expressed as the salary expenditure at
salary levels 3 to 6 Salary level 3 is at R54 876 salary level 4 is at R64 410 salary level 5 at
R76 194 and salary level 6 is at R94 000 for n=11568 working-man hours lost and staff
replacement and overtime
4515 Finance officers
Finance officers are reflected in tables 5 and 7 as represented by 21 (n=83) of the total
working population (n=4010) and 26 (n=386) indicates the working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The cost to the
Department is reflected as salary expenditure from salary level 2 at R47 787 to salary level
10 at R217 482 for R2 728 working hours lost The institutions reflected a small number of
this occupational category as permanent employees place them in the category of scarce
skills
4516 Administration staff
The administration staff is represented in tables 2 and 4 and 5 by 116 (n=466) in the total
working population (n=4010) and 153 (n=2272) indicates the working-man hours lost in
relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 567 represent the working-man days lost in relation to the total number of
full time employees in the four hospitals (n=4010) The cost of leave of absence to the
department is reflected as salary expenditure at salary level 4 to 12 Salary 4 at R64 410 to
salary level 12 at R407 745 for 18176 working hours lost
4517 Administration support
The administration support is reflected in tables 2 and 4 and 5 as represented by 273
(n=1095) of the total working population 354 (n=5248) indicates the working-man days
lost in relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 1309 (n=5248) indicates the working-man days lost in relation to the total
number of employees in the four hospitals (n=4010) The total cost to the Department is
reflected as salary expenditure at salary level 2 to 3 at a cost of R47 787 to R54 879 for
41984 working -man hours lost
The highest percentage of absenteeism in the different categories of employees in the four
hospitals is identified in the administration support category It is this category that falls into
the salary range of 2 and 3 which is classified in the Gauteng Province 20089 annual report
(20089325) as lower skilled employees This category represents the highest single
category of employees for the Department at n=1095
52
The impact to the core service delivery employees that require support from administration
staff would seem to be negative as the absence of employees from the workplace would
hamper the smooth workflow Barker (2007214-224) acknowledges the decline in the flow-
through rate in the school education higher grades namely Grade 11 and Grade 12 and
ventures to give possible reasons for this phenomenon The Gauteng Department of Health
as a possible employer has attracted a high percentage of the labourer category as
identified in table 3 totalling n=1095 which is 273 of the total workforce Pousette and
Hanse (2002230-231) suggest that the employeersquos authority to make decisions in his or her
job and the breadth of use of skills used by the employees at work become different aspects
of control with human service at work This approach suggests that reduced job autonomy is
associated with higher sickness absence The administrative support employees are involved
in mechanical or manual labour that predisposes them to musculo-skeletal problems The
work environment could have a negative impact to the high absenteeism rate in this group
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM AS REPRESENTED BY
THE HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 43 reflects the absenteeism rate of the different occupational groups as represented
by the hospitals The George Mukhari Hospital contributes 7079 to the total workforce
and contributes about 779 to absenteeism The absenteeism rate does seem to be low at
7 when considered in the light of the contribution The question that maybe be raised is
whether the relative low absenteeism is indicative of high morale of a happy workforce
53
ODI 17
TARA 93
GERMISTON 111
GEORGE MUKHARI 779
Germiston Hospital contributes 106 to the total workforce and the absenteeism is
reflected as 111 which seems to be above its contribution to the workforce by 1 The
professional nurse and the administration category present with the highest rate of
absenteeism in this hospital The Tara Moross Centre Hospital contributes 67 of the total
workforce and the absenteeism rate is at 93 which is 26 higher The administration
support and professional nurses present with the highest level of absenteeism in this
hospital The ODI Hospital contributes 6 to the total workforce and the absenteeism rate
which seems to be low is reflected as 17 This hospital has no access to the Persal system
and is dependent to a neighbouring hospital It is highly probable that the information is not
accurate
Allen (1984 331) found that union members might be absent more frequently from the
workplace than non-members because they face smaller penalties for absenteeism The
Charted Institute of Personnel and Development (CIPD) (200811) claim that the 2006
survey of absence management portrays the public sector employees as less likely to be
dismissed for reasons of workplace absenteeism
TABLE 8 SALARY RANGE IN RELATION TO ABSENTEEISM (SALARY RANGE 1-12)
SALARY RANGE DAYS OF ABSENCE PERCENTAGE
1-2 178 12
3-4 5235 353
5-6 2044 138
7-8 5139 346
9-10 1878 126
11-12 366 25
TOTAL 14840 100
(Source Compile by the researcher C S Ndhlovu 2012)
Table 8 reflects the salary range with the lowest working days lost as salary level 1 to 2 This
is proportional to the number of employees The highest absenteeism rate has been noted
in the salary range at level 3 to 4 while salary ranges at level 11 to 12 reflected a low rate of
absenteeism The latter salary range is at middle management level and the responsibility
the employees carry may be responsible for the low absenteeism rate Rogers and Hertin
(1993219) noted that the level of education seem to have influenced the use of sick leave
where the lower level category employees were found to have higher level of absenteeism
than higher educated employees
54
TABLE 9 AGE IN RELATION TO ABSENTEEISM
AGE IN YEARS DAYS OF ABSENCE PERCENTAGE
20 to 24 16 010
25 to 29 405 272
30 to 34 733 493
35 to 39 1582 1066
40 to 44 2676 1803
45 to 49 3318 2235
50 to 54 3046 2052
55 to 59 2235 1506
60 to 64 829 558
TOTAL 14840 9999(100)
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 9 reflects age in relation to absenteeism in the four hospitals The age group at 20 to
24 years reflects the lowest figure in working-man days lost at 010 (n=16 days)
Reday-Mulvey (200579) observed that employees over 45 years take marginally fewer short
sick leave days per year than those under 45years
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 to 55 years
as middle -age and shows this group as presenting with a high incapacity leave usage In the
research the age group 45 to 49 years presented with 2235 (n=3318) working-man days
lost and is the highest figure of absenteeism in all age groups The age group at 20 to 24
years is reflected as the lowest absenteeism rate in working-man days at 010 and this
could be related to the number of employees in this age group
According to Reday-Mulvey (20057988) and the Canadian Nurses Association (20065)
employees that are over 45 years take marginally fewer short sick leave periods but take
slightly longer sick days per year than those under 45 years and reflect higher absenteeism
in the age group above 50 years
55
Weeks (200454) found that employees at the age group represented by 51 to 60 years
show less absence which may be because of ill health retirement benefits The age 31 to 40
and 41 to 50 years show higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full time jobs and suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee In the study the age group 55 to 59 years show a decline in absenteeism in
comparison to 50 to 54 while age 60 to 64 shows the lowest rate
The aging employee has been found to expose the institutions to high levels of absenteeism
through a higher probability of becoming incapacitated for longer periods (Ferguson et al
200138) and the current research have pointed differently Rogers and Hertin (1993219)
found a significant correlation between the use of sick leave and age suggesting employees
with advanced age used more sick leave in comparison with the younger employees The
current socio-economic culture encourages retirement from active employment at the age
of 65 years and the research adopted that approach as a cut off point for employment
(Nichols amp Evangelisti 2001285)
TABLE 10 GENDER IN RELATION TO ABSENTEEISM
GENDER TOTAL
NUMBER
DAYS OF
ABSENCE
PERCENTAGE
Males 1006 2490 168
Females 3004 12350 832
Total 4010 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 10 reflects gender in relation to absenteeism The duration of working-man days lost
is higher in female employees at 8325 (n=12350) and is represented by 749 (n=3004) in
relation to the total number of employees in the four hospitals (n=4010) as represented in
table 3 The male employees employed by the Department are reflected as absent from
work by 1680 (n=1006) and represented as 251 in relation to the total number of
employees in the four hospitals (n=4010)
The Public Service Commission (PSC 200222) found that more males took sick leave than
females except for the age group of 16 to 19 years QUALSA (200923) noted that females
had the highest number of incapacity applications in comparison to their male counterparts
Qualsa attributed this pattern to the fact that female employees constitute a higher
percentage of the employee population within the Gauteng Department of Health
56
Roger and Hertin (1993222) noted that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees could have an
impact on the high number of absenteeism reflected by the women
452 Race in relation to absenteeism
The working population of the four hospitals is represented by four race groups such as
Africans Whites Coloureds and Indians
4521 Africans
Africans represent 973 (n=3902) of the total working population (n=4010) and 963
(n=14295) indicates the working-man days lost in relation to the total working-man days
lost (n= 14840) times the percentage 3565 (n= 14295) reflects the working-man days
lost in relation to the total number of employees in the four hospitals (n=4010) The 14295
working-man days lost are multiplied by 8 hours that represent a day and translates into
963 (n=114360) working-man hours lost The cost to the Department is translated as
salary expenditure for n=114360 workingndashman hours lost and the indirect cost of staff
replacement and overtime Africans constitute the highest number of employees as well as
the highest percentage of working-man hours lost Absenteeism percentage is proportional
to the employment figures for this race group
4522 Whites
Whites are represented as 13 (n=51) of the total workforce (n=4010) and 16 (n=242)
represent the working-man days lost in relation to the total working-man days lost
(n=14840) times percentage 61 (n=242) represent working- man days lost in relation to
the total number of employees in the four hospitals The 232 working-man hours lost are
multiplied by 8 hours that represent a working- man day that translates into 16 (n=1856)
working-man hours lost The cost to the Department is represented as salary expenditure of
(n=1856) working-man hours lost that is paid to the unproductive employees This race
group of employees is not represented in all occupational categories and salary ranges
which may explain the low figures and percentages associated with working-man days lost
(n=242) The demographics of the different hospitals may contribute to the low
representation of this group in the total workforce
4523 Coloureds
Coloureds are reflected as 11 (n=43) of the total workforce (n=4010) 14 (n=201)
represent working- man days lost in relation to the total working- man days lost (n=14840)
5 (n=201) indicates working- man days lost in relation to the total number of employees in
the four hospitals (n=4010)
57
The cost to the department is represented as salary expenditure for n=1608 working-man
hours that are lost This race group is represented in three of the four hospitals and not in
all categories and salary ranges which may explain the low representation and
absenteeism
4524 Indians
Indians represent 03 (n=14) of the total workforce (n=4010) in table 6 07 (n=102)
represent working- man days lost in relation to the total working- man days lost (n= 14840)
times percentage 25 (n=102) indicates working- man days lost in relation to the total
number of employees in the four hospitals (n=4010) The 102 working- man days lost are
multiplied by 8 hours that represent a working-man day and translates into 07 (n=816)
working- man hours lost The cost to the Department is expressed as salary expenditure
paid to the unproductive employees for duration of (n=816) working-man hours lost This
race group is not represented in two of the four hospitals in some occupational categories
and salary ranges The Indian race group is represented by the lowest figure of employment
and lowest percentage of leave of absence which is proportional to the employment figure
FIGURE 44 RACES IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 44 reflects the different races in relation to absenteeism The Africans as a race
group is represented by 963 of working-man days lost (n=14840) The high figure of lost
working-man days reflects the demographics of the four hospitals
58
14840 DAYS
(100)
Africans 963
whites 16
coloureds 14
Indians 07
The George Mukhari Hospital is in a semi-rural setting that is predominantly African
populated and employs the highest number of Africans as represented in table 1 (n=2836)
Whites are presented by 16 absenteeism rate and not represented in all occupational
categories and salary ranges which could explain the low figures and percentages associated
with lost working days The absenteeism rate for Indians is represented as 07 and
Coloureds as 14
The Africans as a race group constitute the highest number of employees as well as the
highest percentage of working days lost Absenteeism percentage is proportional to the
employment figures for this race group The Indian race group is represented by the lowest
figure of employment and lowest percentage of leave of absence which is proportional to
the employment figure The South African Survey Millennium (1999-200028) reflected the
African males in 1998 as 354 and females as 348 the Coloured males as 39 and
females as 46 Indian males as 39 and females as 15 and White males as 83 and
females as 94 There has been no significant change in the race group representation in
the working population of the four hospitals
453 Tenure in relation to absenteeism
Tenure in years is grouped in units of ten (10) Tenure in 1 to 10 years 11 to 20 years 21 to
30 years 31 to 40 years of all occupational groups are represented in figure 27 as the total
leave of absence utilised by the full-time employees of different occupational groups in
terms of tenure which translates into n=14840 working-man days lost The lowest hours lost
is at tenure 31 to 40 years of service which is reflected as 59 (n=878) working- man days
lost The highest working-man days lost is at tenure of service of 11 to 20 years reflected as
443 (n= 6577) working- man days lost Tenure of service of 1 to 10 years reflects 30
(n=4451) working-man days lost and tenure of years at 21 to 30 years reflects 198 (n=
2934) working- man days lost
Rogers and Hertin (1993222) express tenure as work experience in years that is viewed as a
predictor of employee productivity where seniority has been found to be inversely related to
absenteeism in terms of frequency and total number of work days lost The Canadian Nurses
Association (20065) suggests that job tenure increases with age as illustrated in their
research where nurses were found to have both job tenure of 20 years or more and are over
45 years of age In the research the tenure of 31 years to 40 years presented with the lowest
absenteeism rate in agreement with Rogers and Hertin (1993222)
59
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 45 reflects the total leave of absence from tenure of 1 year to 40 years The PERSAL
system reflected 40 years as representing more or less 64 years of age and 65 years is the
cut off point for full time employees in the system The lowest working- man days lost is at
tenure of 31 to 40 years of service which is reflected as 590 and represents the older
employee in general The highest working- man days lost is reflected at tenure of 11 to 20
which is presented as 4430 representing the younger employee This is an area of concern
as table 5 reflects professional nursesrsquo absenteeism rate at 208 and administration
support staff at 356 and is possible that the absenteeism rate of the two occupational
categories may be a bigger contributor to the high absenteeism rate reflected in the tenure
of 11 years to 20 years
454 Salary range in relation to absenteeism
The salary range is interpreted in the study as a salary broad band that is represented in
table 9 and ranges from level 1 to 12 Rogers and Hertin (1993 219) claim that the level of
education does seem to have a bearing on the salary range use of sick leave where the
lower level category employees were found to have higher levels of absenteeism than the
higher educated employee The Human Resource Development Strategy (Gauteng Province
200815214) claims that the chances of entering into a higher income bracket in South
Africa rises noticeably after people have twelve years of education The ages 20 to 24 years
are greatly affected by this assumption
60
0
20
40
60
Tenure 1-10Tenure 11-20
Tenure 21-30Tenure 31-40
30 4430
1980
590
Tenure
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 46 above reflects the salary range from 1 to 12 in relation to working- man days lost
as salary range 1 to 2 as n=178 working-man days lost which converts to 12 The highest
absenteeism rate has been noted in the salary range at level 3 to 4 at 3530 (n=5235)
working-man days lost while salary ranges at level 7 to 8 is reflected as the second highest
level of absenteeism at 346 (n=5139) lost working-man days
Salary range at 5 to 6 is reflected as the third highest in absenteeism at 138 (n=2044) lost
working-man days Salary range 9 to 10 is regarded as the entry point to middle
management and is reflected as the fourth highest at 126 (n=1878) working-man days
lost Salary range at 11 to 12 is regarded as middle management entrusted with high levels
of authority and accountability This group is reflected as losing 25 (n=366) working- man
days lost which is considered to be a reasonable low level of absenteeism
455 Age of full time employees in relation to absenteeism
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 years to 55
years as middle-age and shows this group as presenting with a high incapacity leave usage
In the research the age group of 45 years to 49 years is represented with 2235 (n=3318)
working- man days lost and is the highest figure of absenteeism in all age groups
61
178
5235
2044
5139
1878
366
0
1000
2000
3000
4000
5000
6000
Salary range1-2
Salary range3-4
Salary range5-6
Salary range7-8
Salary range9-10
Salary range11-12
DAYS OF ABSENTEEISM
Reday-Mulvey (20057988) and Canadian Nurses Association (20065) observed that
employees over 45 years take marginally fewer short sick leave periods but take slightly
longer sick days per year than those under 45 years and reflect higher absenteeism in the
age group above 50 years
Weeks (200454) claims that the age group at 51years to 60 years show less absence may be
because of ill health retirement benefits The age group of 31 years to 40 years and 41years
to 50 years show a higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full-time jobs He suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee The aging employee has been found to expose the institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods
(Ferguson et al 200138)
Rogers and Hertin (1993219) claim that there is a significant correlation between the use of
sick leave and age suggesting employees with advanced age comparatively used more sick
leave in comparison with the younger employees The current socio-economic culture
encourages retirement from active employment at the age of 65years and the research
adopted that approach as a cut off point for employment (Nichols amp Evangelisti 2001285)
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 47 reflects the number of working-man days lost by full-time employees through
absenteeism related to a specific age
62
16
405
733
1582
2676
3318
3046
2235
829
0
500
1000
1500
2000
2500
3000
3500
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Days of absence
Days of absence
Age groups are organised in units of 5 to be consistent with the Personnel and Salary
Administration System (PERSAL) The age group at 20 years to 24 years reflects the lowest
percentage of absenteeism at 010 (n=16) working-man days lost and the age group of 45
years to 49 years reflect the highest days of absenteeism at 2235 (n=3318)
456 Gender in relation to absenteeism
The females employed in the Department of the four hospitals are represented as 749
(n=3004) in relation to the total number of employees in the four hospitals (n=4010) and
lost 8320 (n=12350) working-man days This absenteeism rate is considered high
considering that not every female employee may have used sick leave The male employees
employed in the Department are represented by 25 (n=1006) of the total workforce
(n=4010) and lost 168 (n=2490) working-man days The findings suggest that males
utilised fewer days of sick leave considering the fact that not every male employee may
have utilised sick leave for the duration of the study
The Public Service Commission (PSC 200222) claims that more males took sick leave than
females except for the age group of 16 years to 19 years QUALSA (200923) noted that
females had the highest number of incapacity applications compared to their male
counterparts Qualsa attributed this pattern to the fact that female employees constitute a
higher percentage of the employee population within the Gauteng Department of Health
Rogers and Hertin (1993222) argue that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees may have an
impact on the high rate of absenteeism
63
FIGURE 48 GENDER IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 48 reflects gender in relation to absenteeism The females employed by the
department in the four hospitals are reflected as absent from work at a rate of 8320
(n=12350) working-man days and represented by 749 (n=3004) in relation to the total
number of employees (n=4010) in the four hospitals The male employees employed by the
Department are reflected as absent from work at 1680 (n=2490) and represented as
251 (n=1004) in relation to the total number of employees in the four hospitals
(n=4010)
457 Week days in relation to occupational groups
Table 11 reflects the trends in terms of days of the week that show high utilisation by the
different occupational groups Mondays Fridays and Thursdays reflect a high utilisation rate
by the employees suggesting a pattern of high absenteeism rate over weekends
Professional nurses and sub-categories and the administration support group reflected the
highest absenteeism over the weekends
64
1680
8320
000
1000
2000
3000
4000
5000
6000
7000
8000
9000
Males Females
GENDER ABSENCE
TABLE 11 WEEK DAYS IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
OCCUPATIONAL
CATEGORY
MONDAY TUESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Doctors 18 8 13 17 0 0
Professional
Nurse
135 86 94 137 0 0
Staff Nurse 52 38 56 65 2 0
Nursing
Assistant
62 27 34 45 2 0
Administration
Staff
64 38 58 73 1 0
Administration
support
252 147 98 126 26 15
Finance officer 17 4 8 16 0 0
TOTAL 600(4) 348(23) 361(24) 479(32) 31(02) 15(010)
(Source Compiled by C S Ndhlovu 2012)
Table 11 reflects the pattern of how the different occupational groups utilised sick leave on
the different days of the week It illustrates the days that sick leave started on each day of
the week The largest number of incidences of sick leave commence on Monday the first
working day of the week as reflected by 4 (n=600) of the days of the weekend Fridays are
the second highest days of absenteeism represented by 32 (n=479) Tuesdays and
Thursday are almost the same in utilisation as reflected by 23 and 24 respectively
Professional nursesrsquo absenteeism was pronounced on Mondays as 2250 (n=135) and
Fridays as 2861 (n=137) a trend that shows possible long weekend absenteeism
The administration support staff has been reflected as mostly absent on Mondays 42
(n=252 days) and Fridays 2631 (n=126 days) The administration support reflected the
highest days of absenteeism on Saturday (n=26) and Sunday (n=15) The Canadian Nurses
Association (CNA) (2006) focused on seasonal pattern of absenteeism in the different
categories in the different hospitals The PSC (2002) report identified a trend by provincial
employees of using sick leave to extend their weekends The research considered working-
man days lost in terms of days of absence as in accordance with evidence of a medical
certificate Administration support is the only group that seem to have utilised Saturdays
for sick leave 8387 (n=26) and Sundays 100 (n=15) days
65
TABLE 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALS
INSTITUTIONAL
CONTRIBUTION
TARA MOROSS
CENTRE
GERMISTON ODI GEORGE
MUKHARI
TOTAL
Contribution to
Sample
668 1070 1182 7080 100
Contribution to
Absenteeism
842 1177 165 7816 100
(Compiled by C S Ndhlovu 2012)
Table 12 reflects the contribution of each hospital to absenteeism Tara Moross Centre
Hospital contributed 67 to the sample and the absence rate is higher than the
contribution at 84 The Germiston Hospital contributed 107 to the sample and the
absenteeism rate is higher at 117 The George Mukhari Hospital contributed 708 to the
sample and absenteeism rate is at 782 and ODI Hospital contributed 118 and
absenteeism rate is at 17 The latter hospital has no computers at The reflection of the
status of absenteeism is likely to be inaccurate The George Mukhari Hospital has the
highest contribution to the sample yet leave of absenteeism is tolerable It raises questions
as to what should be the contributory factor to the leave of absence status in this hospital
46 CONCLUSION
Chapter 4 presented the analysed data in terms of the characteristics as determined in the
stratified random sampling The characteristics and their association with absenteeism have
been presented such as occupational categories age gender tenure of service and race
The research identified which days of the week were utilised for sick leave absence The
contribution of each hospital to absenteeism was identified and a brief overview of each
hospital was presented
Chapter 5 presents the findings conclusion and recommendation of the research
66
CHAPTER 5
FINDINGS CONCLUSIONS AND RECOMMENDATIONS
51 INTRODUCTION
Chapter 1 provides a general introduction to the research It included the background and
motivation for the research that provides the context the problem statement and the
significance of the research The key concepts are defined The research design the method
of data collection the sampling method data analysis and interpretation and limitations to
the research are explained in this chapter
Chapter 2 considers the theoretical foundations concepts characteristics theories
approaches and classifications of workplace absenteeism The discussions on the conceptual
framework of absenteeism predictors of absenteeism and various models of absenteeism
are presented Measures to control workplace absenteeism and the impact of absenteeism
in an institution and management intervention strategies in workplace absenteeism were
discussed
Chapter 3 describes the research design and the different aspects of the research methods
that were applied to the research The chapter explains the various data collection
techniques that are used unit of analysis units of observations construct validity and
ethical considerations
Chapter 4 provides the organisational structure of the Gauteng Department of Health
comparisons of hospital employees different race groups of the four hospitals gender
comparisons in different hospitals and comparisons of the different occupational groups It
provides a short description of the target hospitals The research interpretation is discussed
in terms of the different occupational groups and absenteeism different races and
absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism The trends of week days of
absenteeism in the four hospitals and contributions to absenteeism by the four hospitals are
presented
Chapter 5 explains a synthesis of the study and evaluation of workplace absenteeism The
findings of the research and recommendations are discussed
52 FINDINGS
The findings of the research reflect doctors as represented by 108 in the total workforce
(n=4010) have an incidence of 29 (n=435) of the total work-man days lost (n= 14840) by
the employees in the four hospitals translating to a total of n=3480 working hours lost
67
The working-time lost is considered against the doctorsrsquo workload of 226 in contrast to the
target of as 227 while the national target was 187 The bed occupancy rate target was 75
while the actual figure was 653 The annual report when it is interpreted in conjunction
with the sick leave absence of doctors at 29 shows no negative impact on the workload in
terms of service delivery The negative impact is mainly on the cost factor to the state as the
doctorrsquos salary level is from salary level 10 at a cost of R217482 to salary level 12 at
R407745 (Gauteng Province annual report 2008951) Serneels et al (2008210) claim that
absenteeism occurs primarily in the public sector associated with people who hold two jobs
and that is highest and more frequent amongst doctors The findings of the research of
absence of 29 with a contribution of 2 to the sample are in disagreement with the
Serneels et al findings
Professional nurses represent 196 (n=785) of the total workforce (n=4010) The
workplace absenteeism is represented as 77 (n=3088) of the total workforce (n=4010)
translating into 21 of working-man days that are lost (n=14840) The absenteeism rate
appears to be very high given the fact that nurses by virtue of their numbers are the
backbone of health care service delivery (DPSA 2009) The Gauteng Province annual report
of 2008951 reflects the total vacancy rate of nurses at 697 as against the national target
of 15 The absenteeism rate of 77 is very high when compared with the total vacancy
rate and 19 contribution to the sample Staff nurses are a sub-category of the nursing
profession and the impact of their absence to service delivery is the same as the
professional nurses The findings of the study reflect staff nurses representing 12 (n=482)
of the total working force (n=4010) The absenteeism from staff nurses is reflected as 13
(n=1956) of the total working-man days lost (n=14840) The absenteeism rate does appear
to be high when considering the contribution of 13 to the absence rate by a sample of 12
to the total working-man days lost Nursing assistants are a sub-category of the nursing
profession that is reflected as 107 (n=429) of the total number of employees (n=4010)
and represent 97 (n=1445) of the total working-man days lost (n=14840) This absence
rate is considered as high when compared with the total number of employees
The nursing occupational group considered collectively contributed to absenteeism at the
workplace at 997 which is extremely high Davey and Cummings (2009312-313) claim
that frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased
staff morale and high cost to health care The high absenteeism rate has a negative impact
on health care service delivery
The findings of the research reflect administration staff as 116 (n=466) of the total
number of employees (n=4010) represented by 154 (n=2286 days) of the total working-
man days lost (n=14840) Administration support is at salary level 1 to 2 with exceptional
instances of salary level 3 to 4
68
Administration support staff is reflected as 273 (n=1095) of the total workforce (n=
4010) represented by 356 (n=5289 days) of the total working-man days lost (n=14840)
translating to n=42312 lost working-man hours
The administration staff viewed collectively contributed 51 to absenteeism which is very
high with the support staff reflected as 356 Rogers and Hertin (1993219) claim that the
level of education seem to have influenced the use of sick leave where the lower skilled
category of employees were found to have higher levels of absenteeism than higher
educated or skilled employees The findings of the research reflect the administration
support staff to be in line with the Roger and Hertin findings
The Gauteng Department of Health has a limited number of finance officers causing them to
be a scarce skill occupational group The finance officers represent 2 (n=83) of the total
workforce (n=4010) The working-man days lost are reflected as 23 (n=341) of the total
working-man days lost (n=14840) The total absence at 23 is higher than the actual
contribution to the sample at 2
The age group of 45 years to 49 years reflects the highest absenteeism rate at 224
(n=3318) the age group at 50 years to 54 years is reflected as 205 absenteeism The age
group 40 years to 44 years reflected as 18 absent from the workplace The age group of 55
years to 59 years is reflected as 15 absenteeism Employees of advanced age used more
sick leave in comparison with the younger employees This phenomenon could be attributed
to the ageing process of the body and the onset of incapacity Absenteeism has been found
to be higher in employees who are over 50 years of age and the phenomenon is attributed
to age and changing abilities that increase when work is performed full- time The findings
of the research reflect the age group over 50 years at 205 and reflect the highest
absenteeism rate at age 45 years to 49 years as 224 (McGoldrick amp Arrowsmith 200184
MINTRAC 20093 Nichols amp Evangelisti 2001285 Reday-Mulvey 200579-194) According to
Ferguson et al (200138) the aging employee presents with high levels of absenteeism
through higher probabilities of becoming disabled for longer periods The findings of the
study reflect absenteeism of the age group of 55 years to 59 years at 15 which is the
lowest in the age groups The Canadian Nurses Association in (20065) noted a reduction in
workplace absenteeism rate among nurses who are less than 45 years of age and an
increase in the absenteeism rate among nurses above 55 years of age According to Bangali
(20043-4) the falling rate of the older employee age group could be influenced by the
practice of early retirement or voluntary severance which was used in the 1990s as a
method of restructuring in institutions Rogers and Hertin (1993219) claim employees with
advanced age used more sick leave in comparison with the younger employees
69
The group at tenure 11 to 20 years presented with the highest level of absenteeism at
443 The employee at tenure of 21 to 30 years presented with 198 of absenteeism rate
while the employees at 1 to 10 years presented with the rate of 30 The findings of the
research reflected tenure of 31 to 40 years to have presented with the lowest absenteeism
rate at 59 (n=878 days) This low absenteeism rate could be ascribed to the fact that
numbers of employees are reduced in this group or could also be commitment to their jobs
or could have higher ambition levels to aspire to higher posts
Van Der Westhuizen (2006136) and Rogers and Hertin (1993222) express tenure as work
experience that may be viewed as a predictor of employee productivity where seniority has
been found to be inversely related to absenteeism in terms of frequency and total number
of working-man days lost The public service employees enjoy security of tenure which may
contribute to the unacceptably high levels of absenteeism (Andrews 1997221ndash222
MINTRAC 20093)
The findings of the research reflect females as 75 of the total workforce (n=4010)
represented by 832 (n=12350) of the total working-man days lost (n=14840) The males
represent 25 of the total workforce (n=4010) and are reflected as absent at 168
(n=2490) of the total days of absence (n=14840)The absenteeism rate is very high for
females in this research Rogers and Hertin (199322) and Van Der Westhuizen (2006136)
suggest that women are absent from workplace more than men are Landstad et al (20011)
found that women cleaners who received preventive personnel support depicted a
reduction in absenteeism rate Hoxsey (2010562) claims that although women presented
with a high score of job satisfaction than men they maintained higher levels of
absenteeism MINTRAC (20094ndash8) found that gender moderates the age turnover
relationship Women are more likely to remain in their jobs the older they get than men do
The findings of the research reflect Africans as represented by 26 of the working
population and utilised 963 of the total working-man days lost due to sick leave It is
possible that the overall number of Africans influenced what seems to be a high level of
absenteeism at 963 Whites represented 03 of the working population and
absenteeism is reflected as 16 of the total working-man days lost Coloureds are
represented by 03 of the working-man population and absenteeism was recorded as 14
of the working-man days lost The Indians are represented by 01 of the total working
population and are reflected as 07 of the working-man days lost
The findings of the research reflect the salary range at level 11 to 12 utilised 25 working-
man days for sick leave salary level 7 to 8 which is the supervisory level utilised 346
working-man days lost salary level 3 to 4 which is the entry level of skilled workers utilised
353 working-man days lost The findings suggest management used fewer days of sick
leave in comparison to the supervisory level and entry skilled worker level
70
This can be ascribed to the fact that they are ultimately responsible for the institutionrsquos
effectiveness and productivity
The George Mukhari Hospital contributed 708 to the sample and reflected 771
absenteeism which is relatively low in comparison to the size of the contribution It could be
that processes and procedures of controlling leave of absence are in place The Tara Moross
Centre Hospital contributed 67 to the sample and reflected 93 absenteeism rate that is
high by 26
Professional nurses reflected a trend of high absence over the weekend including
Thursdays This could be a sign of burn out and extending the period of rest from possible
high workloads resulting from high vacancy rates (Gauteng Province annual report 20089)
Nyathi (200059) and the PSC (2002) found that employees are absent from work because
they want to prolong the weekend
53 CONCLUSIONS
The absenteeism rate is very high for females in this research The aging employee presents
with high levels of absenteeism through higher probabilities of becoming disabled for longer
periods The use it or lose it approach of the current system rewards the abuse of sick leave
as it is viewed as not being beneficial by the employees to act responsibly towards the use
of sick leave
The vacancy rate of 697 in the professional nurse category and the absence rate of 208
in 2008 in the four hospitals can only suggest inadequate levels of human resource for
effective efficient quality health care services at a high cost to the Province The nurses
may not be aware of the actual absenteeism or they under-estimate it The combination of
high registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery
Professional nurses and administration support staff have absented themselves from the
workplace predominantly on Mondays and Fridays It could be for various reasons ranging
from feelings of burn out to extending the weekend
The percentage of working-man days lost in relation to the total number of full-time
employees in the four hospitals is reflected as 488 which is very high as there is no
deterrent not to abuse sick leave in the public sector The findings of the research found a
significant correlation between the occupation and use of sick leave age and the use of sick
leave gender and use of sick leave and tenure and use of sick leave
71
The biggest hospital George Mukhari presented the lowest rate of absenteeism for its size
and complexity which reflects an empowered management The Tara Moross Centre
Hospital is the smallest hospital highly specialised and presented with high rate of
absenteeism for its contribution which may be a reflection on the skills of its management
or the type of health care service that is offered by the institution
The international norm of absenteeism is 3 The research established the absence rate at
488 The Gauteng Department of Health is held at ransom by the five trade unions it has
signed agreements with and that makes it difficult for managers to manage absenteeism
The practise of Gauteng Department of Health Head office to remove managers from
institutions when there is a labour unrest exacerbates the problem of managing
institutions
The findings of the research could not establish a representative reflection of race and
absenteeism as Indians Coloured and Whites were not represented in some institutionsrsquo
demographics
54 RECOMMENDATIONS
The White Paper on Transforming Public Service holds management responsible for
delivering specific levels of services and for obtaining value for money in wider utilising of
resources This strategy is to be translated into action The Gauteng Department of Health
should probably benefit by adopting the total absence management philosophy by
cultivating a culture that is not tolerant of high levels of absenteeism through building it in
as a key performance area of the performance of all managers and all employees The
current performance dimension system should lay explicit emphasis on this aspect
The re-engagement of knowledge based and professional retirees at reasonable
remuneration levels to reward their expertise may assist in reviving good work ethics by
mentoring the new and generally young recruits The retired professionals are currently
resisting the call for re-employment on a contract basis at entry level
The Gauteng Department of Health can encourage flexitime in terms of 58 or 68 to allow
the mature employee to remain within the system with the view to share their knowledge
and skills with the young employees who may be highly qualified but lack experience This
approach may deal with the need for adequate human resources for health care delivery at
reduced cost as two employees on flexitime basis can occupy one full-time employeersquos post
Managers should use the return-to-work counselling strategy to solicit feedback from the
employee about the actual absenteeism The counselling should be on a one-to-one basis
This approach may raise self-awareness to the employees in terms of the impact of the
employeersquos absence frothed workplace
72
Currently this intervention strategy is not adequately utilised for fear of confrontation with
labour representatives
Managers should have attendance policies in place effectively communicate policies to
employees adhere to policies and procedures and use absence control strategies
consistently This approach will minimise the feeling of injustice by employees Currently the
human resource unit is challenged by a high staff turnover due to promotions from the
human resource area a situation that creates a vacuum and lack of continuity weakening
the process of empowering line managers by human resource practitioners This high staff
turnover may be controlled through upgrading of the human resource salaries as the
salaries fall out of the occupation service dispensation (OSD)
Managers in the public service are expected to be responsible and accountable for their
portfolios including management of leave of absence and should not shift it to the human
resource unit as is currently the practice It should be possible to charge a manager as an
accomplice for failing to manage the absence of employees where there is no evidence of
corrective remedial action where it has been warranted The researcher takes cognisance of
the fact that the public service is highly unionised and this approach may trigger industrial
action
The employer needs to revive on the job in-service education and training as a way of
imparting institutional values such as attendance at the workplace in partnership with
recognised labour representatives through bilateral and multilateral forums and through
institutional skills development committee which should be representative of all
stakeholders with the view to promote stability in the workplace and indirectly enhance
productivity and reduce workplace absenteeism Currently the bilateral multilateral and
skills development committees are inactive in the institutions that were targeted and
management seems to be intimidated by the militant labour representatives
High levels of absenteeism among some occupational groups do suggest a need for an active
employee assistance programmes at all hospitals Employee wellness committees are
currently inactive There is a sporadic intervention approach at some institutions where
PILIR Committees are active Employee assistance programmes should be budgeted for as a
standing on-going programme in all hospitals There is a need for a thorough research as to
why absenteeism remains high in the public service and focus on absenteeism broadly
73
BIBLIOGRAPHY
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African National Congress
Allen SG 1984 Trade union absenteeism and exit-voice Industrial and Labour Relations
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Auriacombe CJ 2001 Guidelines for drawing up research proposals and preparing
thesesdissertations Pretoria University of South Africa
Amin S Das J amp Goldstein M (eds) 2008 Are you being serviced Newtools measuring
service delivery Washington DC The International Bank for Reconstruction and
DevelopmentThe World Bank
Andrews Y 1997 The personnel function University of Pretoria Kagiso Tertiary
Babbie E 1992The practice of social research6th edition California Wadsworth
Bamford L Klein amp Engelbrecht B 1999 How to monitor and address absenteeism in
district hospitals for sub-district support initiative for sub-district support Cape Town
KWIK-SKWIZ 25 Press Gang
Bangali A 2004 Are older workers genuine assets for economy Strategies and possibilities
for effective use of their human resource potentialTuebingen Eberhard Karls University
Barker F2007The South African labour market theory and practice5th edition Pretoria
Van Schaik
Bendix S 2000 Industrial relations in South Africa4th revised edition Lansdowne Juta
Bergdahl M 2001 How-Malrt minimises business with HR practices Human Resource
Development Gauteng College Regional Academy Leadership Journal 6
Breetzke A 2009 Managing absenteeism Available at httpwwwIrnetworkcoza
(Accessed on 05082009)
Brink H 1996 Fundamentals of research methodology for health care professionals
Kenwyn Juta
74
Brynard PA amp Hanekom SX 2005 Introduction to research in Public Administration and
related academic disciplines Pretoria Van Schaik
Burton JP Lee TW amp Holtom BC 2002The influence of motivation to attend and
organizational commitment on different types of absence of behavioursJournal of
Managerial Issues14 (2)
Buschak M Craven C amp Ledman R 1996 Managing absenteeism for productivity SAM
Advanced Management Journal6 (1)
Camp S amp Lambert EG 2005 The influence of organizational incentives on absenteeism
Sick leave use among correctional workers Available on
httpwwweascnoaagov(Accessed on22052009)
Canadian Nurses Association 2006 Trends in illness and injury ndashrelated absenteeism and
overtime among publicly employed registered nurses Canadian Nurses Association Ottawa
Available on httpwwwcna-aiicca (Accessed on 30032009)
Chaudhury Namp Hammer JS 2003Ghost doctors absenteeism in Bangladeshi health
facilitiesWorld Bank Policy Research Working Paper 3065 May Available
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Charted Institute of Personnel and Development 2008Absence managementAnnual survey
report Charted Institute of Personnel and Development July Reference 4513 Available at
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Cloete JJ 2004South African public administration and management2ndimpression
Pretoria Van Schaik
Clark RL 2007The emergence of phased retirement economic implications and policy
concerns Ontario John Deutsch Institute for the study of economic policy
Dagmara S 2000Whorsquos minding the hospitals Absenteeism soars HampHN Hospitals amp
Health Networks 74 (4) April 14ndash143 Available at httpwwwoasisunisaacza(Accessed on
20072011)
Davey MMamp Cummings G 2009 Predictors of nurse absenteeism in hospitals a
systematic review Journal of Nursing Management 17 312ndash330 Available on httpO-
webebscohostcomoasisunisaacza (Accessed on 30072011)
Department for Public Service and Administration1997White paper on transforming public
service delivery Pretoria Public Service Commission
75
Department of Public Service and Administration 2007 Determination on working time in
the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Determination of leave of absence
in the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Policy and procedures on incapacity
leave for ill-health retirement (PILIR)Pretoria National Office
De Wit P 2006 Reasons for absenteeism in the Department of Defence Pretoria Tshwane
University of Technology
Du Toit Damp Van Der Waldt G 1998 Public management grassroots Cape Town Juta
Du Toit D Knipe A Van Niekerk D Van Der Waldt Gamp Doyle M 2001Service
excellence in governance Cape Town Heinemann
Du Toit D Bosch D Woolfrey D Godfrey S Rossouw T Christie S Cooper C Giles
G amp Bosch C 2003Labour relations law a comprehensive guide4thedition Durban
LexisNexis Butterworths
Erasmus B Swanepoel B Schenk H Van der Westhuizen EJamp Wessels JS 2005 South
African human resource management for the public service Pretoria Juta
European Foundation for the Improvement of Living and Working Conditions
(EFILWC)1997Preventing absenteeism at the workplace Ireland Office for Official
Publication on the European Committee
Fakie SA 2005Report on the Auditor-General on a performance audit of the management
of sick leave benefits at certain national and provincial departments Pretoria Department
Public Service and Administration (DPSA)
Ferguson T D Muedder Kamp Fitzgerald R M2001 The case of total absence
management and integrated benefitsHuman Resource Planning24 (3)
Finnemore M amp Van Rensburg R 2002 Contemporary labour relations Johannesburg
LexisNexis
Gaudine A amp Gregory C2010The accuracy of nursesrsquo estimates of their absenteeism
Journal of Nursing Management 18599ndash605
Gauteng Province 2007 Human Resource Development Strategy for Gauteng for Gauteng
maximizing human capital for shared growth Pretoria Government Printers
76
Gauteng Province 20089 Annual report Pretoria Government Printers
Gauteng Province 2010 Monitoring and Evaluation Policy FrameworkGauteng Provincial
Government Office of the Premier
Ghauri P Gronhaug Kamp Kristianslund I 1995 Research methods in business studies
England Prentice-Hall
Goldsmith Mamp Morgan H 2003 ldquoLeadership is a contact sport The ldquofollow up factorrdquo in
management development The 5th Annual Global Learning SummitResearched and
organised by SALVO 20ndash24Feb
Goldstein M2008Why measure service delivery Are you being serviced New tools for
measuring service deliveryEdited byAmin S Das Jamp Goldstein MWashington DCThe
International Bank for Reconstruction and DevelopmentThe World Bank
Griep RH Rotenberg L Chor D Toivanen SampLandsbergis P2010Beyond simple
approaches to studying the association between work characteristics and absenteeism
Combining the DCS and ERI modelsRoutledge Taylor amp Francis GroupWork ampStress 24 (2
April-June)179ndash195Available athttpwwwinformaworldcom (Accessed on 20072011)
Grogan J 2003 Workplace law 7 th edition Lansdowne Juta
Grogan J 2005 Dismissal discrimination and unfair labour practices Lansdowne Juta
Hirschfield RR Schmitt LPamp Bedeian GA2002 Job-content perceptions performance-
reward expectancies and absenteeism among low-wage public-sector clerical employees
Journal of Business and Psychology 16(4) Human Sciences Press Available on
rhirschfterryugaed(Accessed on 30032009)
Hoxsey D2010Are happy employees healthy employees Researching the effects of
employee engagement on absenteeismCanadian Public Administration53 (4) p551-
571Canada The Institute of Public Administration of Canada
Jacobs EJamp Roodt G 2011 The mediating effect of knowledge sharing between
organisational culture and turnover intentions of professional nursesSouth African Journal
of Information Management
Jankowitz E 1991Terminating for absenteeism practical labour management Rivonia IR
Data Publication 1(10)
Keese M2006 Live longer work longerDELSA Newsletter OECD Available at
httpwwwoecdorgelsemployment(Accessed on 10072011)
77
Lambert EG Camp SD Edwards Camp Saylor WG 2005 Here today gone tomorrow
back again the next day absenteeism and its antecedents among Federal Correctional
staffWashington DC Ohio
Landstad B Vinberg S Ivergard TT Gelin G ampEkholm J2001Change in pattern of
absenteeism as a result of workplace intervention for personnel support Ergonomics
001401391544 (1)
LexisNexis 2006Labour Law Reports July 1994ndashDec2006CumulativeIndex Durban
LexisNexis
LexisNexis 2007 Legislation and strategyLexisNexis (9)Durban Butterworths Available at
httpwwwmylexisnexiscoza (Accessed on 15072011)
Madibana LF 2010 Factors influencing absenteeism amongst professional nurses in
London Pretoria University of South Africa
Markussen S Rogeberg OJ amp Gaure S 2009 The anatomy of absenteeism IZA
Discussion Paper Series No 4240 June Bonn Institute for the Study of Labor
McCormick ET amp Ilgen D1985 Industrial and organizational psychology 8th edition New
Jersey Prentice-Hall
McGoldrick E amp Arrowsmith JJ 2001Discrimination by age the organizational response
Ageism in work and employment Edited by Glover IampMohamed Sterling Management
SeriesEngland University of Sterling
Mellor N Arnold Jamp Gelade G2009The effects of transformational leadership on
employees in four of UK public sector organisations Health and Safety Laboratory for the
Health and Safety Executive UK RR648 Research Report
MINTRAC 2009 Literature review on labour turnover and retention Available at
strategieswwwmintraccom (Accessed on 14042009)
Mouton J2005How to succeed in your Masterrsquos and Doctoral studies a South African guide
and resource book Pretoria Van Schaik
Munro L 2007 Absenteeism and presenteeism possible causes and solutions The South
African Radiographer45(1) Available onhttpsorsaorgza(Accessed on 10072011)
Nel PS Gerber PD Van Dyk PS Haasbroek GD Schultz HB Sono TampWerner A
2001 Human resource management5th edition New York Oxford
Nel PS Kirsten M Swanepoel BJ Erasmus BJampPoisant P 2008South African
employment relations theory and practice6th edition Pretoria Van Schaik
78
Nichols AampEvangelisti W2001 Fitness for work the effect of aging and the benefits of
exerciseSterling management series ageism in work and employmentEdited by Glover
LampMohamed B England University of Sterling
Nyathi MN 2000Factors contributing to absenteeism among nurses a management
perspective Pretoria University of South Africa
Patrick MN 2001Positive psychological functioning among civil servantsPretoria
University of South Africa
Paton N2010 Long-term absence hand in hand Occupational Health Reed Business
Information UK Reed Elsevier Available athttpebscohostcomoasisunisaacza
(Accessed on 10072011)
Parbhoo S2003 Why worry about absenteeism in the workplace CCMA PublicationCCMA
Mail July
Pierce K2009 The impact of absenteeism in the public service in the context of GEMS
Pretoria GEMS Government Employees Medical Scheme [lsquoslrsquo]
Public Service and Co-ordinating Bargaining Council (PSCBC) 2000Resolution 72000
Polit DF amp Hungler BP 1995 Nursing research principles and methods Philadelphia
Lippincott
Pousette A amp Hanse JJ 2002Job characteristics as predictors of ill-health and sickness
absenteeism in different occupational types-a multigroup structural equation modelling
approachNational Institute for working life TaylorampFrancisSweden Goteborg Available on
httpwwwtandfcouk (Accessed on 10072011)
Public Service Commission2002Sick leave trends in the Public Service Pretoria Public
Service Commission
QUALSA Report 2009Policy procedure incapacity leave and ill-health retirement Steering
Committee QUALSA [rsquoslrsquo]
Reday-Mulvey G 2005Working beyond 60 key policies and practices in Europe New York
Palgrave Macmillan
Republic of South Africa 1995 Labour Relations Act 66 of 1995
Republic of South Africa 1997 Basic Conditions of Employment Act 75 of 1997
Republic of South Africa 2001 Public Service Regulation 2001
79
Republic of South Africa 2011 ldquoTowardsquality care for the patientrdquo National Core
Standards for Health Establishments in South Africa Pretoria Government Printers
Robbins SP amp Decenzo DA 2001 Fundamentals of management essential concepts and
applicationsNew Jersey Prentice Hall
Robbins SP Odendaal A amp Roodt G2004Organizationalbehaviour Global Southern
perspective 5th impression Cape Town Pearson
Rogers RE amp Hertin SR 1993Patterns of absenteeism among government employees
Public Personnel Management22 (2)Available at httpwwwquestiacom (Accessed on
10012009)
Serneels P Lindelow MampLievens T2008Qualitative research to prepare quantitative
analysis absenteeism among health workers in two African countriesAre you being
serviced New tools for measuring service deliveryEdited by Amin S Das
JampGoldsteinM2008 The International Bank for Reconstruction and DevelopmentThe
World Bank for Reconstruction and Development Washington D C The World Bank
Slabbert JA amp Swanepoel BJ 2001Introduction to employment relations
managementDurban Butterworths
South African Survey Millennium1999-2000 Johannesburg South African Institute of Race
Relations
Steers RMamp Rhodes SR 1978Major influences on employee attendance a process
model Journal of Applied Psychology63 (4)391-407
Oi-ling S2002Experience before and throughout the nursing careerPredictors of job
satisfaction and absenteeism in two samples of Hong Kong nursesJournal of Advanced
Nursing 40 (2)218ndash229 Available on httpwwwebscohostcomoasisunisaacza
(Accessed on 10072011)
Todd C2001Contract of employment Claremont Siber Ink
Tonya TW2001Minimizing absenteeism in the workplace strategies for nurse managers
Nursing Economics19 (2 MarApril) 53 3 Available at httpwwwoasisunisaacza
(Accessed on 14012009)
Tustin C 1994Industrial relations a psychological approach1st edition Halfway House
Southern Publishers
80
Unruh Jamp Strickland M2007 Nurse absenteeism and workload Negative effect on
restraint use incident reports and mortality JANORIGINAL RESEARCH Journal compilation
Florida Blackwell
Van der Westhuizen C 2006Work related attitudes as predictors of employee absenteeism
Pretoria University of South Africa
Venter R 2003 Labour relations in South AfricaRevised edition Cape Town Oxford
University Press
Viviane IJ 2011Absenteeism among women workers in industry85 IntrsquoLab Rev 248
(1962) Available at httpwwwHeinonlineorg(Accessed on 18052012)
Weeks KL 2004 Development and initial characteristics of a comprehensive survey on
workplace absenteeism Logan Utah State University Available on
httpwwwoasiscomunisaacza(Accessed on 14012009)
Welman JC amp Kruger SJ2001Research methodology for the business and administrative
sciences 2nd edition New York Oxford
Yende PM 2005 Utilising employee assistance programmes to reduce absenteeism in the
workplace JohannesburgUniversity of Johannesburg
81
ANNEXURES A B C
ANNEXURE A
PROCESS EVALUATION QUESTION COMPLIANCE
YESNO
ACTION PLAN
Retention and Reward -
leave
1 Are there complete and
accurate Z 1(Leave application
forms) forms on file
2 Have all application forms been
approved stamped and
registered
3 Have all forms been captured
on the Persal with the following
requirements
Supporting documents
A 10 day compulsory leave
processed within the annual
leave cycle Determination of
Leave
4 The remaining days are utilized
6 months from the end of the
leave cycle
5 Are there unutilized leave days
6 Has there been adequate
checking of leave reasons
Leave credits
Adherence to leave categories
(i)Normal ( ii) Incapacity
(iii) Injury on duty (iv) Maternity
(v)Adoption (vi) Family
responsibility
(vii) Office bearersshop stewards
and Casual Employees
7 Have work reasons been
provided for leave days
(Source Compiled by C S Ndhlovu 2012)
82
ANNEXURE B
Retention and
reward ndashsick leave
Evaluation Question Compliance YesNo Action Plan
1 Are there medical
certificates that have been
submitted to all medical
claims with the following
Specific illness stated
Supporting documents on
file
2 Has the 8 week rule for
36 days in a 3 year cycle
been adhered to
3 Are there complete
medical certificates for 3
days or more sick leave
days for normal sick leave
4 Are all other leave days
above 3 days utilized after
36 days treated as
temporary incapacity
leave
5 Are temporary
incapacity leave forms
submitted within 5 working
days after the first day of
absence
6Is there a register for
temporary incapacity
leave for 1 to 29 days lead
time for reporting leave
applications
7 Has the employer
approveddeclined the
leave application within 30
working days of receipt
(Source Compiled by C S Ndhlovu 2012)
83
ANNEXURE C
CHECK LIST
Is there a leave register in place for all leave applications
1 Is leave approved prior to the employee proceeding on leave
2 Area attendance registers maintained and up to date
3 Are periodic audits for leave carried out
4 Is there evidence of GSSCrsquos approval on leave applications
5 Are leave forms accurately captured on Persal
6 Are leave forms accurately completed by applicants
7 Is movement of leave forms monitored between the GSSC and institutions
8 How is rejected leave application dealt with
(Source Compiled by C S Ndhlovu 2012)
84
LIST OF TABLES
Table 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
Table 2 COMPARISONS OF NUMBERS OF ADMINISTRATIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
AND SUPPORT STAFF IN THE DIFFERENT HOSPITALS
Table 3 GENDER COMPARISON IN DIFFERENT HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Table 4 COMPARISON OF TENURE OF SERVICE IN RELATION TOhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
ABSENTEEISM IN THE FOUR HOSPITALS
Table 5 COMPARISON OF THE OCCUPATIONAL GROUPShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip45
IN THE DIFFERENT HOSPITALS
Table 6 RACES IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip48
Table 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Table 8 SALARY RANGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip54
(SALARY RANGE 1-12)
Table 9 AGE IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip55
Table 10 GENDER IN RELATION TO ABSENTEEISMhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Table 11 WEEK DAYS IN RELATION TO ABSENTEEISM INhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip65
THE FOUR HOSPITALS
Table 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALShelliphelliphelliphelliphelliphelliphelliphelliphellip66
IX
CHAPTER 1
GENERAL INTRODUCTION
11 INTRODUCTION
The Gauteng Province is viewed as a province of opportunities by South Africans as well the
neighbouring countries such as Mozambique and Zimbabwe The impact of these
perceptions has placed a heavy demand on services including health provided within the
confines of the province the results being an increase in the workload of the employees
The indirect results of the increase in the workload have been unacceptably high levels of
absenteeism seemingly sub-standard levels of health care and high cost of delivering the
health care services Absenteeism poses a threat and can lead to the collapse of health care
services if absenteeism is poorly managed The research examines the management and
control of absenteeism in four out of thirty four hospitals that service the province The
hospitals that have been targeted for the research are ODI District Hospital Germiston
Hospital TARA Moross Centre Hospital and George Mukhari Hospital
This chapter explains the background and motivation for the research The research
highlights the problem statement which focuses on the effective management of
absenteeism The objectives of the study the research methodology and structure of the
research are explained The relevant literature review was consulted for the research The
key concepts that are used in the research are conceptually defined The research design is
a descriptive stratified random survey The data that were used were collected in three
phases the unit of analysis were the employees of the Gauteng Department of Health in the
four target hospitals and the unit of observations were observations of the employees of
the four hospitals The construct of validity was achieved through using a variety of data
collection methods Ethical considerations were taken into account during the research
process Limitations of the research were imposed by the uniqueness of each of the target
hospitals The structure of the research and the reference technique is explained in this
chapter The research on absenteeism in the Gauteng Department of Health is confined to
the period of 1 January 2008 to 31 December 2008 and focused on the working-man days
lost how absenteeism is managed and employee well-being and rehabilitation
12 BACKGROUND AND MOTIVATION FOR THE RESEARCH
The Gauteng Department of Health received a qualified report in 2008 on the control of sick
leave A performance audit was conducted by the Public Service Commission (PSC) (2002
xvi) into the information required to effectively manage sick leave in the public service
1
The research on absenteeism in Gauteng Department of Health seeks to examine the extent
of workplace absenteeism in the ODI District Hospital which is in a transitional stage from
North West to the Gauteng Province The hospital falls under Tshwane Metropolitan
Municipality and is in Region C The Germiston Hospital falls under Ekurhuleni Metropolitan
Municipality in Region B TARA Moross Centre Hospital is in Region A under the
Johannesburg Metropolitan Municipality and George Mukhari Academic Hospital is Region C
under the Tshwane Metropolitan Municipality The research seeks to examine the degree of
compliance by the four hospitals with the recommendations of the performance audit of
management of sick leave in the light of the qualified report received by the Gauteng
Department of Health (Human Resources) in 20089
13 PROBLEM STATEMENT
The Gauteng Department of Health provides health care services as the core business of the
Department The Health care services are labour intensive and high levels of absenteeism by
its employees undermine the Departmental efforts to deliver quality health care to the
people of Gauteng The problem statement therefore is to examine to what extent the
effective management of absenteeism can enhance the effectiveness of the Gauteng
Department of Health
14 AIM AND OBJECTIVES OF THE RESEARCH
The aim and objectives of the research are explained in this section
141 AIM
The aim of the research is to determine how the effective management of absenteeism can
contribute to the effective health care of Gautengrsquos communities
142 Objectives
The objectives of the study are
to determine the impact of the variables such as age gender occupational category
and salary level on workplace absenteeism
to determine whether the correlation between absenteeism levels and tenure of
service does exist
to determine trends of workplace absenteeism in different employee categories and
to establish the different challenges confronting the different hospitals in
management and control of absenteeism in terms of size complexity and location
2
15 LITERATURE REVIEW
Various studies have been conducted to examine workplace absenteeism in different fields
in government and private institutions Van Der Westhuizen (200636) research focused on
high and low combinations of job involvement and organisational commitment The
outcome was not emphatic on the findings as predictors of the turnover and absenteeism
The research noted that women are more absent from the workplace than men De Wit
(2006) focused on the nature of absenteeism the impact of absenteeism on the
organisation reasons for and causes of absenteeism and measurement of absenteeism and
the findings were not able to find a high coefficient in the test sample
Camp and Lambert (20054) found that the use of sick leave as an incentive to reduce sick
leave by the employees under the Civil Service Retirement System (CSRS) led to a reduction
of absenteeism as a result of sick leave when compared with employees who functioned
under the conditions of the Federal Employees Retirement System (FERS) who within the
same company lost the unused sick leave when they retired
Ferguson Ferguson Muedder and Fitzgerald (200138) focused on the impact of
absenteeism and cost in terms of time lost in the Total Absence Management (TAM)
concept and found that the aging employee exposes institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods of
time
Serneels Lindelow and Lievens (2008210) claim absenteeism is high among employees in
the public sector in developing countries due to a lack of accountability and a lack of
punishment for transgression
The research seeks to determine the extent of the problem of workplace absenteeism its
impact and management in the identified hospitals It seeks to establish the relationship if
any between the various variables and absenteeism such as age occupation tenure salary
level gender and race
16 TERMINOLOGY
Key concepts that are used in the research are conceptually defined however a
comprehensive concept clarification will be done in chapter 2
Workplace absenteeism Workplace absenteeism is the absence of employee at the
workplace that is defined by Du Toit and Van Der Waldt in (1998139) as the place that the
institution makes available and where officials have to perform their work
3
Workplace forms part of the internal environment for public administration in the public
service Robbins Odendaal and Roodt (200415) define absenteeism as the failure of an
employee to report for work as scheduled regardless of the reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work According to
Venter (2003267) desertion occurs when the employee leaves the place of employment
without the intention to return to work
Employee An employee is defined as any person employed in terms of the Public Service
Act 1994 irrespective of rank or position (Public Service Act 1994 Subsection 15) Todd
(20011) refers to an employee as any person excluding an independent contractor who
works for another person and is entitled to be paid for it or who in any manner assists in
carrying on or conduct the business of the employer Bendix (2000123) defines an
employee as a person in a workplace except a ldquosenior managerial employeerdquo whose status
and contract of service grants the employee the authority to represent the employer in
interactions with the workplace forum to determine policy on behalf of the employer and
make decisions which might conflict with representation of workers at the workplace
Employer An employer as an individual person who may be the employer in legal terms as
well as the organisation which is responsible for implementing Public Service human
resource management policies (RSA 1997 Section 15)
Leave cycle The Public Service Act 1994 refers to the leave cycle as 36 months employment
with the same employer
Quality Is defined as getting the best results possible within the available resources (RSA
2011)
Standard Is a statement of an expected level of quality delivery A standard reflects the
ideal performance level of a health establishment in providing quality care (RSA 2011)
17 RESEARCH DESIGN AND METHODOLOGY
This section deals with the research design and methodology
171 Research design
Research design is the overall plan for relating the conceptual problem to relevant empirical
research It is a quantitative descriptive research that involves the systematic collection of
numerical information under conditions of considerable control (Polit amp Hungler 1994
24175)
4
The choice of the research design influences subsequent research activities such as
identifying the target subjects what data to collect and how they should be collected The
research design is a descriptive stratified random survey which is concerned with
characteristics of a specific population subject at a fixed point in time for comparative
purposes The focus is on a representative sample of the relevant population It is concerned
with the accuracy of the findings and their generalisability The survey is used to gain deeper
insight of the behaviour of employees with regards to motivation satisfaction and
grievances (Babbie 199289 Ghauri Gronhaug amp Kristianslund 199527 60 Brink 199611
6 Welman Kruger amp Mitchell 200152)
172 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services Four hospitals of the thirty four health care delivery institutions have been
identified for the research
Each hospital is unique in its character in terms of specialisation of health care delivery
service The four hospitals are located in Tshwane Johannesburg and Ekurhuleni
Metropolitan Municipalities The sample is a stratified random sampling which is composed
of various clearly recognisable non-overlapping sub-populations (strata) that differ from
one another mutually in terms of variables that are a combination of more than one
variable such as age sex income level or educational level The purpose is to ensure that
every part of the population (every stratum) is represented The members of a particular
stratum are homogeneous in the population at large The sample is representative of a
population with clearly distinguishable strata with a greater degree of certainty (Babbie
199267 Brynard amp Hanekom 200544 Ghauri et al 199578 Brink 1996138 Welman amp
Kruger 200155-56 Welman et al 201061 Polit and Hungler 199518) The data were
collected in three phases
The first phase of data collection was done through auditing of hard copies of identified
personnel files representing ten files per hospital and using the tool in annexure A amp B The
forty employeesrsquo profiles were accessed through the Human Resource Information
Management system (HRIM) located in the Gauteng Department of Health Head Office The
respective employeesrsquo profiles were handed over to the human resource manager in the
respective hospitals on the morning of the audit for the human resource practitioner to
draw out the hard copy files for auditing The characteristics of the individuals that were
identified for the first phase were males and females and the different race groups The
auditing of the files was for the complete working life of the employees and not confined to
2008 only Registers that are used by the human resource administration to control the
movement of the leave forms were inspected as evidence of the control system in place
5
The purpose of auditing the files is to gain insight into how leave in general was captured
managed and controlled by the hospitals The second phase of data collection was done
through structured interviews with the four human resource managers who were directly
accountable for management and control of leave of absence in general in the four
hospitals
A structured interview provides for a more organised approach and a more stable basis for
assessment of the different candidates (Erasmus Swanepoel Schenk Van der Westhuizen amp
Wessels 2005250) The structured interview was conducted using the tool in annexure C
Tara Moross Centre Hospital had been functioning without a manager in human resource
and the manager that was interviewed had been in the post for three months The human
resource practitioner who was at salary level 8 acting in the Assistant Directorrsquos post
(manager) was invited to join the manager and be part of the structured interview ODI
District Hospital had three human resource practitioners including the accounting officer at
level 8 and in an acting capacity
The third phase of data collection was through the Human Resource Information
Management (HRIM) This system used Personnel Remuneration Administration System
(PERSAL) to collect data Data in this system are categorised in salary level date of
appointment occupational category gender age in units of five race employing hospital
employment status in different categories such as session contract and full-time and the
different types of leave of absence
The research used primary and secondary data in analysing sick leave utilised by full time
employees in the identified hospitals for the period of 1 January to 31 December 2008 using
the Personnel Remuneration Administration System The total population sample was four
thousands and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range at level 1 to 12
The research used past events such as sick leave utilised by employees using secondary
data from Personnel Remuneration Administration System falling into the category of a
historical empirical research The interval scale of measurement was used in the
quantitative research and actual numbers are ordered with equal measurement between
each category (Brink 1996 149 Brynard amp Hanekom 2005 28-29 Mouton 2005
52100170)
6
173 Unit of analysis
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the research refers to observation of work attendance by
the employees of Gauteng Department of Health in the four hospitals
The observation deals with the historical events such as employees who have already
utilised sick leave in the workplace The subjects that are studied are the core health care
providers such as doctors nurses and support employees such as allied administration and
administration support (Mouton 200551-52 Welman et al 2001 52-53)
174 Unit of observations
The observations that are made are of health care workers and support teams in Tara
Hospital Germiston Hospital ODI Hospital and George Mukhari Hospitals The unit of
observations describes the characteristics of a large number of individual people such as
gender age salary range occupational category tenure of service and race in relation to
absenteeism in the workplace In the descriptive research the individual characteristics are
aggregated for the purpose of describing a larger group (Babbie 199292)
18 CONSTRUCT VALIDITY
Construct validity is concerned with the question what construct is the instrument actually
measuring(Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with the four accounting officers in leave management The third phase was collecting of
personnel data through the Persal system
19 ETHICAL CONSIDERATIONS
Ethical considerations included among other issues the protection of the unit of analysis and
unit of observations from discomfort and harm by not revealing information which can
cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity Anonymity is achieved
when the researcher cannot link a given response with a given respondent and reporting
aggregate data only When data are collected at one sitting and not over a period of time
makes it possible to achieve anonymity as the need for follow up is eliminated Subjects of
observations are selected for reasons directly related to the problem being studied as the
principle of justice
7
Confidentiality is about the researcherrsquos responsibility to protect all data gathered within
the scope of the research and shared only with people involved in the research (Babbie
1992465ndash466 Brink 199640ndash41 45)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous The interview was part of the actual audit
that was done as part of monitoring and evaluation that was in progress in the Department
of Health following a negative auditor generalrsquos report about management of leave in
general The managers were put at ease as they were given the check list afterwards for
self-monitoring for future self-auditing
The data that were collected through Personnel Remuneration Administration System
(Persal) identified employees through the Persal number and kept their identity anonymous
The data that were collected through the hard copy of employeesrsquo files were used to point
out areas of concern to the managers and the files did not leave the office of the manager
at the end of the process once more protecting the identity of the employee
110 LIMITATIONS OF THE RESEARCH
The research was conducted on four hospitals of different sizes specialisation and three
metropolitans with unique challenges The period of the research was confined to a
calendar year (2008) and not a financial year The focus was on absenteeism due to sick
leave of full time employees There is no distinction that is drawn between the working-man
days that are lost between shift and non-shift workers The findings may be different if all
absenteeism of employees at the time were considered for the research
111 STRUCTURE OF THE RESEARCH
Chapter 1 It provides a general introduction to the research It includes an introduction the
background and motivation for the research that provides the context the problem
statement and the significance of the research The key concepts are defined The research
design the method of data collection the sampling method data analysis and
interpretation limitations to the research are explained in this chapter
Chapter 2 This chapter considers the theoretical foundations concepts characteristics
theories approaches and classifications of workplace absenteeism Conceptual framework
of absenteeism predictors of absenteeism and various models of absenteeism are
explained Measures to control workplace absenteeism the impact of absenteeism in the
institution and management intervention strategies are explained
Chapter 3 It describes the research design different aspects of the research methods
applied and the data collection techniques used unit of analysis units of observations
construct validity and ethical considerations
8
Chapter 4 This chapter provides the organisational structure of the Gauteng Department of
Health comparisons of hospital employees different race groups of the four hospitals
gender comparisons in different hospitals and comparisons of the different occupational
groups It provides a short description of the target hospitals The research interpretation is
discussed in terms of the different occupational groups and absenteeism different races
and absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism
The week days absenteeism pattern and contributions by the four hospitals to absenteeism
are presented in this chapter
Chapter 5 It provides a discussion of the research evaluation of workplace absenteeism
findings recommendations and limitations
112 REFERENCE TECHNIQUE
The reference technique that is applied in the research involves all sources that have been
consulted while doing the research When legislation is used as a source of information
reference to the specific act is used
113 CONCLUSION
Chapter 1 provides a discussion on the background and motivation of the research problem
statement and the objectives The significance of the research in South African public
institutions and private institutions of other countries and the possible contribution of the
study are explored The terminology that is used in the research is contextualised for the
purpose of the research The research design and methodology are presented in this
chapter The units of analysis the units of observation construct validity ethical
considerations and limitations to the research are also presented in this chapter
The next chapter discusses the theories of absenteeism
9
CHAPTER 2
MANAGING ABSENTEEISM
21 INTRODUCTION
The Gauteng Department of Health is classified as a public institution whose existence is
justified on the grounds that it renders health care services to the public The health care
system is encouraged to develop delivery systems and practices that are in line with
international standards management practices that promote efficient and compassionate
delivery of services and ensures respect for human rights and accountability to the public
(African National Congress 199443-44) This objective can only be achieved if the resources
to provide such services are available The human resources are a vital factor for the health
care sector as it is labour intensive Public institutions such as the Gauteng Department of
Health are funded from public funds and if the human resources do not report for work
service delivery is compromised and the cost to the department in the form of salary
expenditure becomes exorbitant as the department must find replacement staff and pay
for overtime as well It is when all these factors are taken into consideration that workplace
absenteeism becomes a cause for concern for the Gauteng Department of Health
In this chapter absenteeism is discussed from a theoretical perspective and informed by
literature review The classification of workplace absenteeism theoretical perspective
definitions dimensions of employment relationship conceptual framework of absenteeism
structural model of absenteeism legislative framework that regulates the employment
relationship and intervention strategies to control workplace absenteeism are explored
22 THEORETICAL PERSPECTIVE OF ABSENTEEISM
According to Viviane (20111) the term absenteeism was first used in Britain during the
First World War in dealing with employed persons It is during the times when production is
of pressing national importance that the absence of employees from the workplace is keenly
felt Absenteeism is considered a good barometer of staff morale an indirect measure of
employeesrsquo health and well-being and is found to be associated with health-related
absences from work Employees who are motivated and committed to their work and
employer have to be very sick before they book off sick (Griep Rotenberg Chor Toivanen amp
Landsbergis 2010179)
McCormick and Ilgen (198556-57) describe job attendance criteria as relating to a tendency
of employees to withdraw from or attend to their jobs The criteria identified were job
tenure occupational category absenteeism and tardiness According to Markussen
Rogeberg and Gaure (20096) employee characteristics such as age gender education and
occupation have a substantial impact on absence behaviour
10
Chaudhury and Hammer (20033) identified that medical skills and nursing skills are
marketable and greatly in demand Doctors and nurses used this opportunity to make
money and work as private health care providers as well as public health care providers
holding two jobs The absence is considered in terms of morning or afternoon absence by
these categories as they are viewed as having a great deal of discretion over where and
when to discharge their public responsibilities The criteria identified were job tenure
absenteeism and tardiness
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) refer to absenteeism
as non-attendance when an employee is scheduled to work The theoretical perspective of
absenteeism takes into account the physical and or psychological absence of the employee
from the workplace or work station at a time when the employee is contractually expected
to be at the workplace According to Andrews (199734-35) the behaviour and actions of
public officials are determined by specific ethical codes of conduct and it is assumed that
their actions are for the benefit of the communities that are serviced by the public officials
Social ethics focus on how the clients of the Department are treated and are therefore
concerned with the impact of decisions on people inside and outside the institution
individually and collectively
Grogan (2005237) states that employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
look for trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
2001 section F(c) In the public sector contractual employee benefits are modified by
collective agreements These benefits are material gains for the employees and have a
monetary value and a cost factor to the employer
The contract of employment often includes insured benefits such as incapacity ill health
and early retirement as the total package other than the remuneration for the time worked
as it is intended to attract retain and motivate employees (Breetzke 20091 Ferguson et al
200137 LexisNexis 2006670 LexisNexis 2007176 Markussen Rogeberg amp Gaure 20093
Tustin 199452) The policy on Determination on Leave of Absence requires a medical
certificate for sick leave of three or more days and for every sick leave day utilised when the
eight week rule has been transgressed (DPSA 2009 Section 14 subsection 147)
Political ideologies influence the work environment resulting in some areas being highly
unionised where unions are perceived to be capable of exerting control over the employer
and employee relations for the primary benefit of the employees
11
It is the work environment which is highly unionised that is characterised by high workplace
absenteeism (Andrews 199736 Breetzke 20091 Du Toit amp Van Der Waldt 1998170139
Tustin 199452) Allen (1984331) claims that union members might be absent more
frequently from the workplace than non-members because they face smaller penalties for
absenteeism According to Markussen et al (20095 21) workplace environments do have an
impact on absenteeism and are influenced by social interaction processes among
colleagues Absenteeism is affected by social norms Workplaces with high employee
turnover rate tend to have high absenteeism The turnover rate is defined on a quarterly
basis as Min (number of entries number of existing persons) divided by the number of
employees at the start of the quarter The Charted Institute of Personnel and Development
(CIPD) (200811) claim that the 2006 survey of absence management portrays the public
sector employees as less likely to be dismissed for reasons of workplace absenteeism A
report by the National Institute of Labour Studies (Tonya 20011) found the rate of
absenteeism increased among full-time employees from 2 4 to 25 within two years
The services that are provided by the Department of Health are divided into two distinct
categories Direct services are those services that are rendered to the clients who are
patients who receive medical treatment from the core employees usually referred to as line
functionaries Direct services can only become effective and efficient when supported by
the services of the support staff that provide indirect health care services When employees
do not present themselves for work when scheduled to work and do so on a regular basis
the situation becomes habitual absenteeism (Du Toit amp Van Der Waldt 199818) The
Gauteng Department of Healthrsquos core function is to provide health care services to the
people of Gauteng Province The provision of health care services is labour intensive and
requires large numbers of personnel for effective service delivery
The workplace which may be physical or virtual for the public service employees represent
the internal environment of the institution The employer who is represented by the
manager determines the workplace for employees
Rogers and Hertin (1993217) explain the Decision Model Theory as a conscious decision by
the employee to stay away from work or come to work based on which motivation is
stronger at that moment It is not based on the ability to come to work
Serneels et al (2008210) claim that absenteeism is rife in the public sector especially where
employees hold two jobs The actions of public officials in the performance of their duties
should be ethically justified as it impacts on the decisions of people within and without the
institution individually and collectively Tension and job insecurity in the workplace
manifests as absenteeism (Andrews 199733-137)
12
Frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased staff
morale and high cost to health care (Davey amp Cummings 2009312-313) It is suggested that
on average health care workers are likely to be absent from work as a result of illness or
injury rather than other occupations Dagmara (20002) states that absenteeism may be a
benchmark of what is happening in the hospital setting Absenteeism is defined as habitually
not coming to work when scheduled to It is an indicator of psychological medical or social
adjustment to work
Absenteeism is measured by frequency or duration of work-days missed Frequency
measures provide a reasonable index of voluntary absenteeism whereby each incidence or
episode of absence is counted regardless of the duration of absence It is defined as the
number of days absent over a given period of time Other measures used were total days
duration and percentage Duration measures provide an index of involuntary absenteeism
such as time lost index To assess absence duration the total number of days is tallied
regardless of the number of incidents (Davey amp Cummings 2009313) High workload is
identified as one of the factors that affect absenteeism rate among health care workers
(Oi-ling 20023)
Workplace absenteeism is costly for an institution in terms of lost working-man days hiring
of staff to close the shortage absent or sub-standard service delivery and poor quality of
services The total cost of employment risk approach is about the estimation of the possible
cost of any absent employee to an institution per hour The annual cost to the institutions
per employee is in terms of direct and indirect costs such as overtime low productivity and
a decline in morale among workers who are expected to cover for an absent employee
(Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
The public service employees enjoy security of tenure which may be a contributory factor
of absence from work without good cause This practice is fostered by the knowledge that
they cannot be easily dismissed from their jobs therefore have the belief it is right to stay
away from work Misuse of sick leave is considered to be an overriding problem in instances
where the employee does not uphold the standard of honesty and incorruptibility or these
values are not considered to be the corporate values and norms of the institution (Andrews
1997 221-222 MINTRAC 20093)
Bangali (20043-5) describes age function in the sociological theory as a natural
characteristic of human beings but also an integral aspect belonging to the structure of the
society The age definition in the labour market is influenced by the structural functionalism
The employees age is categorised in the workplace in terms of functions to be performed
be it physical or intellectual The age group of 35 years to 49 years old employees comprise
the largest age group in the labour market
13
The employees who are less than 20 years of age reflect the highest absenteeism rate while
employees above 50 years of age reflect a decrease in the absenteeism rate The
disadvantage of the older workers is that their disabilities last longer once they are injured
and are more likely to be absent as frequently and more likely to be injured than younger
workers Keese (20062) states that ageism is evident in the public service and describes the
age group 25 years to 49 years old as prime age Rogers and Hertin (1993219) found a
significant correlation between the use of sick leave and age Employees with advanced age
used comparatively more sick leave in comparison with the younger employees The
Canadian Nurses Association (20065) noted a reduction in workplace absenteeism rate
among nurses who are less than 45 years of age and an increase in the absenteeism rate
among nurses above 55 years of age
Camp and Lambert (20054) found that the use of sick leave retention as an incentive to
reduce use of sick leave by the employees under the Civil Service Retirement System (CSRS)
leads to a reduction of absenteeism as a result of sick leave compared to the Federal
Employees Retirement System (FERS) who within the same company lost the unused sick
leave when they retired The Employees Retirement System (FERS) applies the same
principle of handling sick leave as the Gauteng Department of Health in the sense that
unused sick leave is forfeited at the end of the three year cycle (DPSA 2009Section 14)
Unruh and Strickland (2007674) found that absenteeism from the workplace does
contribute to a vicious cycle of a negative work environment which leads to more
absenteeism and increased turnover Absenteeism has been found to be higher in
employees who are over 50 years of age and the phenomenon is attributed to age and
changing abilities that increase when work is performed on a full time basis Part-time
arrangements reduce absenteeism as well as the cost of paying for a senior employee even
if seniority is just in tenure Age has been linked to a negative turnover in an institution The
older employee is less likely to leave the organisation An institution is healthier for a spread
of ages Some organisations consider employees to be older in batches or cohorts of five
such as 40 years to 44 years up to 64 years (Nichols amp Evangelisti 2001285 McGoldrick amp
Arrowsmith 200184 MINTRAC 20093 Reday-Mulvey 200579-194)
MINTRAC (20094-8) states that gender moderates the age turnover relationship Women
are more likely to remain in their jobs the older they get than men do Turnover is
occasionally related or preceded by high workplace absenteeism The occupational category
is linked to skill levels and salary levels The lower skill employees are concentrated in the
lower skill occupations and easily replaceable
14
Hirschfield Schmitt and Bedeian (2002553) conducted a research on low-wage public
sector clerical employees and found that those employees who perceived limited
performance-reward expectancies were likely to be absent more often The link between
skilled employees and absenteeism suggested that employees may have utilised
absenteeism as a means of compensating for perceived workplace contributions not
extrinsically rewarded
According to Gaudine and Gregory (2010599) the Canadian Institute for Health Information
(2007) found that absenteeism was a problem among health care workers in comparison to
other employees in other sectors Unruh et al (2007673) found the combination of high
registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery Markussen et al (200921) claim that the type of occupation an
employee is engaged in has an impact on absenteeism
221 Classification of absenteeism
The employees of the Gauteng province and their attendance at work are the focal point of
the province in relation to service delivery that is customer focused Health care services are
labour intensive and require employees to be at work when scheduled to do so (Gauteng
Province 201015) Workplace absenteeism can present in different forms and levels as a
result of a combination of variables (Andrews 19975 Breetzke 20091) McCormick and
Ilgen (198557) and Davey and Cummings (2009313) classify absenteeism as voluntary
when the absence is based on the conscious decision by the health care giver to withhold
contractual services The absence is uncertified unauthorised and unexcused while
involuntary absenteeism occurs for reasons beyond the control of the health care giver
such as illness injury or family responsibility Employers are challenged with the task of
differentiating between the absence due to elective workplace absence and absence due to
illness incapacity The differentiation is based on whether the illness incapacity is validated
by a legitimate medical certificate in terms of the prescript of section 23 of the Basic
Conditions of Employment Act (BCEA) 75 of 1997 (RSA 1997)
222 Definition of key concepts
Concepts are defined for common understanding in the context of the study
Workplace absenteeism Workplace absenteeism is absence of the employee at the
workplace that is defined by Du Toit and Van Der Waldt (1998139) as the place that the
institution makes available and where officials have to perform their work It forms part of
the internal environment for public administration in the public service Bamford Klein and
Engelbrecht (199911) refer to absenteeism as employees taking time off that has not been
scheduled
15
Breetzke (20091) Camp and Lambert (20054) and Jankowitz (19911) claim that
absenteeism is non-attendance when an employee is scheduled to work The European
Foundation (199711) views absenteeism as temporary or permanent incapacity for work as
a result of sickness or infirmity According to Robbins Odendaal amp Roodt (200415)
absenteeism is a failure of an employee to report for work as scheduled regardless of the
reason
Abscondment and desertion According to Grogan (2005237) abscondment is deemed to
have occurred when an employee is absent from work for a considerable period of time and
the employer infers that the employee does not intend to return to work The employee
should actually intimate expressly or by implication the intention not to return to work
According to Venter (2003267) desertion occurs when the employee leaves the place of
employment without the intention to return to work
Employee The Basic Conditions of Employment Act no 75 of 1997 Section 1 (a) (RSA 1997)
and Todd (20011) refers to an employee as any person excluding an independent
contractor who works for another person and is entitled to be paid for it or who in any
manner assists in carrying on or conduct the business of the employer The courts use the
control test which identified employees on the basis that they were part of the employer
organisation Bendix (2000123) claims that an employee is a person in a workplace except a
senior managerial employee whose status and contract of service grants the employee the
authority to represent the employer in interactions with the workplace forum to determine
policy on behalf of the employer and make decisions which might conflict with
representation of employees at the workplace Du Toit Bosch Woolfrey Godfrey Rossouw
Christie Cooper Giles and Bosch (200368) state that an employee is a person who works
for a single employer in a permanent fulltime capacity is subject to the supervision of the
employer and receives regular monthly or weekly remuneration and is obliged during
working hours to place his or her productive capacity at the employerrsquos prescribed disposal
Employer
Bendix (2000129) defines an employer as any person except an independent contractor
working for another person or the State and who receives remuneration or any manner
assists in carrying out or conducting the business of an employer DPSA (PILIR) (20094)
states that an employer is the Head of Department or a designated office which will be
responsible for the handling and investigation of incapacity leave applications and ill- health
retirement applications
16
23 EMPLOYMENT RELATIONSHIPS
The employment relationship is about balancing the simultaneous convergent and divergent
interests of the employer and the employee in a regulated manner with the aim of getting
the work of the institution done According to Erasmus et al (2005442) an employment
relationship exists when an individual is employed by someone else to be available to work
for that person in exchange for some remuneration It is through this employment
relationship that reciprocal rights and obligations are created between the employer and
the employee The employment relationship is conflictual in nature (Andrews 199736) The
employees through this relationship are enabled to gain access to the rights and benefits
associated with their employment The Labour Relations Act no 66 of 1995 (RSA 1995)
regulates the management of the conflict in the employment relationship through dispute
resolution structures such as the Commission for Conciliation Mediation and Arbitration
(CCMA) Labour Court and Labour Appeal Court when internal processes fail to resolve the
conflict The employment relationship can be traditional or typical and terms and conditions
of service of employment are regulated by collective agreements This is a tacit
acknowledgement of the existence of a typical employment relation
231 Employment relationship as a multi-dimensional phenomenon
Industrial relations and human resource management are bound together by the
employment relationship through labour employer and industrial relation triangle The
employment relationship is characterised by various dimensions as is the case in a broader
society The dimensions are economic legal individual collective and psycho-social (Grogan
200347)
2311 Economic dimensions
The economic dimension arises through the provision of labour by the employee in the form
of skill knowledge energy abilities and productive time to the employer in exchange for
remuneration Barker (200779) states that a reduction in working hours increases the
hourly cost of production in a unit unless there is a commensurate increase in productivity
The economic dimension is highly regulated The contract of employment includes insured
benefits such as incapacity ill health and early retirement The tendering of services by the
employees is a prerequisite to the employeersquos right to claim remuneration (Grogan
200347) According to LexisNexis (2007176) and the Public Service Regulations 2001
Section E E1 the actual contractual benefits are modified by collective agreements in the
public service sector Employee benefits are material gains for employees that have
monetary value and are a cost factor to the employer The Public Service Regulation 2001
Section F (a) states that the Head of Department shall promote economic and efficient use
of resource to improve the functioning of the public service (RSA 2001)
17
According to Ferguson et al (200137) and Erasmus et al (2005380) employee benefits are
the total compensation package other than the pay for time worked offered to employees
either partially or completely funded by the employer contributions In 2006 about R19
billion was lost on account of absenteeism from sick leave (LexisNexis 2006670 Patrick
2001 17)
Employee benefits are intended to attract retain and motivate employees Some of the
benefits offered to employees are mandated by law such as minimum leave provision as
contained in the Basic Conditions of Employment Act 75 of 1997 and Resolution 72000 of
the Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
2312 Legal dimension
The Labour Relations Act 66 of 1995 Section 3 of Schedule 8 requires that while employees
should be protected from arbitrary action employers are entitled to satisfactory conduct
and work performance from their employees The legal framework provides for the
regulatory requirements for human resource management in the working environment
Grogan (200347) and Grogan (2005120) view the employment relationship as formalised
by a legally binding agreement which is the contract The contract is regulated by specific
laws and formal rules with all the inherent rights and responsibilities to the employer and
the employee In terms of the employment contract one of the responsibilities of the
employee is to render service to the employer at specified agreed upon time except where
the employer has authorised the absence of the employee from the workplace Employees
have a fundamental duty to render services and the employer has a right to expect the
employees to tender such services A basic element of the duty to render service is that the
employee must be at the workplace at the specified agreed upon times unless there is
adequate reason to be absent Bendix (2000120) states that a contract is subject to the
terms and conditions of collective agreements The contract is subject to automatic changes
whenever a new collective agreement is in place The contract and its inherent benefits are
breached by elective absence behaviour of the employee The legal dimension has an
impact on the individual dimension
2313 Individual dimension
The employee enters into a working contract with the employer on an individual basis The
contents of the contract are subject to the Basic Conditions of the Employment Act 75 of
1997 The terms and conditions of employment in the public service are subject to collective
bargaining and collective agreements which influence the employment contract in the
Public Service Co-ordinating Bargaining Council (PSCBC 72000 RSA 1997)
18
The contract of employment is entered into between the employer and the employee under
the supervision of the employer and for remuneration purposes
2314 Collective dimension
According to Slabbert and Swanepoel (20017) the collective dimension of the employment
relationship refers to the organised group aspect of the employment relationship which is
between labour as a group and employers and or their representative public sector
institutions The collective dimension aspect of employment relationship pertains to
legislation relating to bargaining dispute resolution and industrial action
2315 Psycho-social dimension
The psycho-social dimension of the employment relationship represents the unexpressed
needs and expectations of the employer and employees It refers to behaviour in the public
sector institutions within the context of the collective dimension (Davey amp Cumming 2009
313 Erasmus et al (2005442) The Public Service Regulation 2001 Section B states that the
Head of Department shall determine the working time of employees and take into
consideration their personal circumstances which have a social dimension (RSA 2001)
24 CONCEPTUAL FRAMEWORK OF ABSENTEEISM
Davey and Cummings (2009322) amalgamated two theories to create a theoretical
framework with the premise that employee attendance is based on two factors the ability
to attend and motivation to attend The theoretical framework focuses on individual work
ethics demographics and from the work environment Some form of absenteeism may be
difficult to prove in a situation where the employer has two or more operational stations or
the employee occasionally operates from a virtual office The duty to render service is
breached by the employee when the employee is physically present and mentally absent as
would be the case of sleeping on duty Workplace absenteeism is multi-dimensional such as
changes in the work environment that overburden the coping mechanism As a result of this
approach a multi-dimensional framework of absenteeism clouds the causative factors of
absenteeism (Breetzke 20091 Patrick 200124 Tustin 199452)
19
FIGURE 21 CONCEPTUAL FRAMEWORK MODEL
(Adapted from Davey amp Cummings 2009320)
The conceptual model uses individual predictors of absenteeism such as age salary level
tenure race gender occupation educational level job satisfaction and organisational
commitment ability to attend and pressure to attend Organisational commitment is
described as having loyalty to the organisation identifying with its core values and
influences whether or not an employee feels it is appropriate to take unauthorised
unscheduled absences Group level absenteeism is not viewed as a predictor of individual
absenteeism (Davey amp Cummings 2009320 Lambert Camp Edward amp Saylor 20058-9)
25 PREDICTORS OF ABSENTEEISM
Oi-ling (20023-6) claims that in Hong Kong there were 47500 work days lost as a result of
employee sick leave in 1998 and suggests the examining of stress levels for nurses in
different cultures to enable a fuller understanding of the predictors of absenteeism as
different cultures accept some predictors and some reject the same reasons for illness
20
Personal characteristics
2Employee value Job
expectation
1Job situation scopejob level role
stress work amp group size leadership
style
4 Satisfaction
with job situation
3 Ability to attend Illness and accidents transport problems
6 Attendance motivation
7 Employee
attendance
5 Pressure to attend work
incentiveswork ethics
Education
salary
tenure age
gender race
Occupation
Lambert et al (20058) claim that organisational commitment job satisfaction job stress
health issues and personal characteristics correlate as regards employee absenteeism The
findings of the research by Van Der Westhuizen (2006136) focused on high and low
combination of job involvement and organisational commitment and the outcome was
emphatic on the turnover as predictor of absenteeism
According to Unruh and Strickland (2007674) absenteeism from the workplace contributes
to a vicious cycle of a negative work environment which leads to more absenteeism and
increased turnover McCormick and Ilgen (198556) describe turnover as dysfunctional
where an employee wishes to leave the institution and the employer prefers to retain the
individual and is functional where the employee wishes to leave the institution and the
employer accepts the termination of services by the employee
De Wit (2006) focused on attitudes towards job factors that had an influence on
absenteeism and was not able to find a high coefficient in the test sample McGoldrick and
Arrowsmith (20018) claim that an organisation is healthier for a spread of ages Ferguson et
al (200138) state that aging employees expose organisations to high levels of absenteeism
through higher probabilities of becoming disabled for longer periods
Oi-ling (20023-6) and Patrick (200124) found that gender and age among other predictors
of absenteeism have a significant influence on absenteeism Age was positively related to
well-being in managers and negatively related to absence frequency among hospital
employees Older employees were shown to have higher responsibility at work and utilised
minimal days for sick leave Female employees were observed to have utilised more
absences than males
Andrews (1997221-222) and MINTRAC (20093-8) state that gender moderates the age
turnover relationship Women are more likely to remain in their jobs the older they get than
men do Turnover is occasionally related or preceded by high workplace absenteeism The
occupational category is linked to skill levels and salary levels The lower skill employees are
concentrated in the lower skill occupations and easily replaceable Public service employees
enjoy security of tenure which maybe a contributory cause of absence from work without
good cause a practice that is encouraged by the knowledge that they cannot be easily
dismissed from their jobs therefore have the belief it is right to stay away from work
Rogers and Hertin (1993217-222) found a correlation between the use of sick leave and
age Employees with advanced age comparatively used more sick leave in comparison with
younger employees The level of education seems to have influenced the use of sick leave
where the lower level categories of employees were found to have a higher level of
absenteeism than higher educated individuals
21
Robbins et al (200447) state that married women employees have fewer absences and
undergo fewer job turnovers Rogers and Hertin (1993222) express tenure as work
experience in years that is viewed as a predictor of employee productivity where seniority
has been found to be inversely related to absenteeism in terms of frequency and total
number of work-man days lost The level of education was found to have an influence
where the lower category of employees was found to have higher levels of absenteeism
than higher educated employees Jacobs and Roodt (2011425) and Davey and Cummings
(2009320) state that an organisational culture in hospitals can contribute towards lower
turnover as the turnover rate is a predictor of absenteeism The process can be facilitated
by promoting knowledge sharing that can provide opportunities that may meet employee
expectations
Pousette and Hanse (2002229-231) suggest that theories that make predictions about
antecedents to ill health and sickness absence make the assumption that the relationships
are the same in different occupations Reduced job autonomy is suggested to be associated
with higher sickness absence The occupation specific model is used in order to identify the
variance in the patterns in terms of occupation-groups Davey and Cummings (2009320)
found that turnover was significantly related to absenteeism
Hirschfield et al (2002553) conducted a research on low-wage public sector clerical
employees and found that those employees who perceived limited performance-reward
expectancies were likely to be absent more often The link between skilled employees and
absenteeism suggested that employees may have utilised absenteeism as a means of
compensating for perceived workplace contributions not extrinsically rewarded Unruh et al
(2007674) found that absenteeism from the workplace does contribute to a vicious cycle of
a negative work environment which leads to more absenteeism and increased turnover
26 A MULTI-GROUP INVARIANCE MODEL
A multi-group invariance structural model represents different types of occupations such as
industrial blue-collar workers industrial collar workers elderly care workers and child
health care workers The focus of this model relates to the extent to which a model that is
assumed to include a general population also includes sub-populations such as different
occupational types The occupation specific model allows different relationships between
variables in different occupations The specific model approach allows for identification of
the most common reasons for absenteeism and early retirement in the workplace and was
successfully utilised in Sweden A common model proposes that absenteeism is a
behavioural response to dissatisfaction with the job (Pousette amp Hanse 2002230-244)
Nyathi (200059) found that professional nurses were absent from work because they
wanted to prolong their weekends
22
Davey and Cummings (2009313) argue that on average health care employees are more
likely to be absent from work as a result of illness or injury than other occupations Paton
(20104) acknowledges that line managers are the fundamental building blocks for reducing
absenteeism and must be provided with the tools to manage absence The absence rate at
3 is considered very high and must be vigorously and progressively managed
FIGURE 22 MODEL SPECIFICATION
(Adapted from Pousette amp Hanse 2002232)
Pousette and Hanse (2002232-245) make the assumption that low job autonomy and low
skill discretion deprive the employees of the opportunity to handle work obstacles and
regulate workload to a manageable level implying a negative relationship to workload has
an impact on absenteeism rate Patrick (200123-24) states that changes in the working
conditions overburden the coping mechanism Work-related stress can lead to deteriorating
physical and emotional well-being The work object is the distinguishing quality between
occupations in the different occupational groups whereby the blue-collar employee works
with things that are tangible such as materials and machines whereas the white-collar
employee is knowledge based employee who is working with data
23
Structural Model
W L Work load
I H Ill-Health
S A Sickness absenteeism
S D Skills discretion
(autonomy)
27 CATASTROPHIC MODEL (CAT)
According to Buschak Craven and Ledman (199628) the catastrophic model (CAT) caters for
major illness that keeps the employee away from work for extended periods of time This
model is similar to short and long term incapacity sick leave whereby the employee has
exhausted the normal sick leave of 36 days which is catered for by DPSA section 14 (RSA
2009)
28 MEASURES TO CONTROL WORKPLACE ABSENTEEISM
The general behaviour and actions of public officials are determined by specific ethical
codes of conduct and the unethical conduct results in effective administration and
unsatisfactory service delivery (Andrews 199733) Effective control of workplace
absenteeism requires an absenteeism policy to be in place management to establish the
magnitude and patterns of absenteeism and raise awareness about the consequences of
breaking these rules (Bamford Klein amp Engelbrecht 19992)
The Determination on Leave of Absence in the Public Service (DPSA 2009 section 14 141)
the Public Service Co-ordinating Bargaining Council Resolution (PSCBC 72000) Davey and
Cummings (2009313) and DPSA (PILIR) 2009 section 3 31 state that an employee is
entitled to 36 working days sick leave with full pay in a three year cycle with the same
employer Any unused leave credits shall lapse at the end of the three year cycle The
employee is expected to utilise and manage the normal leave circumspectly The employee
who chooses to utilise sick leave days must submit a medical certificate for every occasion
of three or more sick leave days utilised The medical certificate must be issued and signed
by a practitioner or persons who are registered with the Professional Councils established
by the Act of Parliament Incapacity leave is additional sick leave granted conditionally at the
employerrsquos discretion An employee who has exhausted the normal sick leave during the
prescribed sick leave cycle and who requires to be absent from work due to a temporary
incapacity may apply for temporary incapacity leave with full pay According to the Policy
and Procedures on Incapacity Leave for Ill-Health Retirement (PILIR) (DPSA 2009) an
employer is not required to pay an employee if the employee has been absent from work
for more than two consecutive days or more than two occasions during an eight week
period and on request does not produce a medical certificate
The Public Service Regulations 2001 F (c) holds the manager accountable when an
employee abuses sick leave (RSA 2001) According to Parbhoo (20036) and Nel et al
(2008145) the doctor patient confidentiality is not above reach to the employment
relationship by suggesting that the employer can question the authenticity or contents of
the medical certificate if there is sufficient reason to do so within the confines of
confidentiality
24
According to Breetzke (20092) South African employees are challenged by global trends to
seek mechanisms to deal with excessive absenteeism at the workplace The Charted
Institute of Personnel and Development (CIPD) (200811) claims that the 2006 survey
showed that public sector employees are less likely to be disciplined or dismissed for
reasons of workplace absenteeism
281 Measuring absenteeism
Measuring absenteeism in the workplace enables the employer to determine the extent and
nature of the problem Absenteeism is measured using two measures total time lost and
absence frequency Nel et al (2001584) In institutions total time lost is determined for
every group of employees and category of absence such as sick absence authorised and
unauthorised absence The recognised international norm is 3 Institutions challenged
whether to accept the international norm as the given or strive to bring workplace
absenteeism down in the interest of quality and quantity of service delivery The total time
lost index is calculated as the Total number of days lost due to absence over the period
multiplied by a thousand and divided by the average number of employees multiplied by a
thousand and divided by an average number of employees multiplied by total work-days
over the period (Amin Das amp Goldstein 20086 Breetzke 20094 Nel et al (2001584)
According to Nel et al (2001584) high workplace absenteeism rate is suggestive of incidence
that is of short duration and therefore more disruptive to the operational plans of an
institution as prior knowledge of pending workplace absenteeism allows for forward
planning and reduction of the costs associated with absenteeism The absence frequency
rate is calculated as Number of absence incidence over the period divided by the average
number of employees employed over the period (Breetzke 20094 Nel et al 2001254)
29 IMPACT OF WORKPLACE ABSENTEEISM
Lambert et al (20056 36) claim that absenteeism has adverse effects on those employees
who are good attenders as they are shuffled around to fill in the positions of absent
employees Organisations suffer the detrimental effects and consequences of employee
absenteeism Management expend valuable time to modify employee assignments to
respond to absences When employees who are in management or in highly specialised job
assignments report sick the work assigned to them remains undone because their positions
remain vacated and the work remains for them to complete The responsibility and
accountability these employees are entrusted with may influence less use of sick leave by
them
The White Paper on Transforming Public Service Delivery (DPSA 1997) holds management
responsible for the specific level of resources and for obtaining value for money in these
resources
25
Madibana (201022) found in the research about absenteeism amongst nurses that the high
rate of absence had an impact in the reduction of quality care rendered by nurses
291 Cost to the institution
Andrews (19978221) describes an institution as the process through which activities are
grouped logically into the distinct areas and assigned to managers It results in the logical
grouping of activities in a department Workplace absenteeism influences the cost of an
institution which influences the quality of the product or service that is rendered by the
institution Employee attendance is a vital element for managing productivity of any
institution and its individual members The unfilled posts reflect the absence of public
health care employees and do not absorb budget resources for salary and upkeep of
facilities Absent personnel still receive their salaries If public servants are not on the job
the expenditures embodied in them do not reach their beneficiaries (Chaudhury amp Hammer
20032 Lambert et al 20055) The cost is direct in terms of salary expenditure or indirect in
terms of staff replacement
Ferguson et al (200138) argue that the cost of employment risk approach is about
estimation of the possible cost of any absent employee to an institution per hour per day
Robbins Odendaal and Roodt (200415) estimate that absenteeism costs South African
institutions millions of rand a year in decreased efficiency and increased benefit payments
Fakie (20053) notes that sick leave costs the national government 15 of the total basic
salary expenditure for the National Department of Health from 1 January 2001 to December
31 2003
The South African Chamber of Business (SACOB) (Patrick 200117) acknowledges that in
2006 about R19 billion were lost on account of absenteeism resulting from sick leave
According to the European Foundation (19977) United Kingdom lost 11 billion pounds in
1994 Germany lost 30 5 billion EUC in 1993 and Belgium lost 24 billion EUC in 1995
Breetzke (20092) describes indirect costs as hidden costs harder to measure and may
include economic value of lost productivity Indirect costs relate to loss of production that
may arise by engaging some expects to provide service in the field where they are closing
the staff shortage gap Rogers and Hertin (19939) and the European Foundation (19978)
view the individual employee and his or her dependants in a social dimension aspect as
exposed to reduced income as a result of extended workplace absenteeism related to ill
health where long term incapacity is involved
The total cost of employment risk approach is about estimation of the possible cost of any
absent employee to an institution per hour The cost may be direct and indirect such as
overtime low productivity and a decline in morale among workers who are expected to
cover for an absent employee (Bangali 200427 Dagmara 20001 Ferguson et al 2001 38)
26
292 Low productivity
According to Jankowitz (19911) high levels of absenteeism are disruptive to production
where operators are interdependent or where levels of service have to be maintained
Buschak Craven and Ledman (199626) argue that absenteeism generates costs for the
institution and productivity problems put an unreasonable burden on the rest of the
employees who are at work An absent employee be it physical or psychological remains an
unproductive employee Absenteeism viewed from an employerrsquos perspective is regarded as
a problem that impacts negatively on service delivery while the employeesrsquo believe their
mere presence in the workplace is being productive
210 MANAGEMENT INTERVENTION STRATEGIES IN WORKPLACE ABSENTEEISM
Managing workplace absenteeism remains a challenge for all employers and the Gauteng
Department of Health has not been spared the challenges faced by other institutions as it
provides health care services to the citizens of Gauteng The provision of good quality health
care is vital for the development of human capital The implications of declining quantity
and quality of care is grave when the human capital equity and efficiency which are the
cornerstones of health care service delivery are threatened by employees who are not at
work when expected to be (Gauteng Province 200711) Misuse of sick leave is considered to
be an overriding problem in instances where the employee does not uphold the standard of
honesty and incorruptibility or these values are not considered to be the corporate values of
the institution (Andrews 1997 221-222 MINTRAC 20093)
According to Grogan (2005237) employees have a fundamental duty to render services and
their employers have a right to expect them to do so Deliberate workplace absenteeism is
regarded as a violation of this contractual obligation The manager in public service is to
identify trends and patterns that indicate abuse of sick leave as the manager is held
accountable when an employee abuses sick leave in terms of the Public Service Regulations
Part V Section F(c) (RSA 2001) The workplace can be a virtual office Workplace
absenteeism is perceived to be high in unionised workplace environments where unions are
perceived to be capable of exerting control over the employer and employee relations for
the primary benefit of the employees In the public sector contractual employee benefits
are modified by collective agreements
Public service managers are to focus towards results achievement and be accountable for
the performance of their institutions (Gauteng Province 201023) Workplace absenteeism
can be reduced by tightening up policies and procedures relating to control of absenteeism
and intensifying monitoring processes on absent employees
27
According to Cloete (2004290-297) public institutions are to provide quality goods and
services The public institutions require an appropriate infrastructure to enable them to
perform their core functions (Bamford et al 19991 Buschak et al 1996 28 Munro
200722)
2101 Effective communication
According to Oi-ling (200212) managers should alter the psycho-social environment at work
and cultivate an institutional climate that supports staff and facilitate effective
communication Institutions should raise awareness to employees of their rights and
responsibilities regarding leave of absence and the consequences of abusing it (Bamford et
al 19992) The policies should be clearly written and well communicated to all employees
and be readily available and accessible In a highly unionised environment these policies are
debated in bilateral or multi-lateral forums between management or employer
representatives and labour representatives The human resource practitioners must conduct
periodic in-house training on these policies for management and employees to facilitate
uniform interpretation and enforce compliance by all stakeholders The policies must be
couched in simple understandable language that is free of legal terms for ease of
comprehension by all users The policies on workplace absenteeism must be explicit of
actions to be taken when policies have been violated or employees are aggrieved
2102 Empowerment of managers
Workplace absenteeism is multi-dimensional requiring inputs from all related fields
Managers require on-going support and training on issues that relate to absenteeism at the
workplace The human resource unit works with managers to establish performance
standards training of employees on the importance of execution and assists managers to
focus on continuous improvements superior execution and employee empowerment
(Bergdahl 20019 RSA 2011)
The labour relations unit supports the training of managers on grievance handling bilateral
and multi-lateral encounters with employee representatives with employee education
issues specific to workplace absenteeism The Charted Institute of Personnel and
Development (CIPD) (200835) reported that 70 of managers in the public service have
been trained in workplace absenteeism handling
Employment relationships bind human resource and industrial relations together with the
common objective of achieving institutional goals and labour peace Managers focus on
managing the institution for productivity at the lowest possible cost by providing quality
care therefore reducing the risk of litigation control of absence from work and work
efficiency
28
It is the delays in dealing with issues that give the employees the feeling of being unfairly
treated and demoralised Consistency in upholding these processes is essential for creation
of a stable employment relationship while any deviation from the set processes give rise to
worker unfriendly environment (Bergdahl 20118-9)
2103 Monitoring of workplace absenteeism
The manager is expected to keep accurate records for all leave of absence taken by
employees In terms of the management of ill-health absencersquos the manager has to ensure
that the eight week rule is observed whereby the employee who has been absent from
work on more than two occasions during an eight- week period must regardless of the
duration of the sickness or injury submit a medical certificate (RSA Part V section F (b)
DPSA 2009 section 14 148) Pierce (200921) believes that management of human capital
may be achieved through the integration of employee benefits employee assistance
programmes and human capital
Monitoring of absenteeism is a human resource function that gets lost in the competing
functions that are carried out by human resource practitioners High levels of absenteeism
are an indication of poor management and or conflict within the employment relationship
The methods to monitor workplace absenteeism vary from one institution to the other It is
human resource management that establishes common guidelines that are used by
management to monitor workplace absenteeism In monitoring absenteeism the manager
considers each employeersquos case on its merit
The manager focuses on certain aspects of the case such as failure to call in on the day of
absence pattern of use of sick leave before or after holidays and sick absence occurring on
certain days of the week or month Monitoring systems to monitor and record attendance
of work are put in place to assist management with simple accurate functional data that
facilitates informed decision- taking at management level The employees of the province
and their attendance at work become the focal point of the province in relation to service
delivery Peer pressure monitoring comes from colleagues at the same facility Hierarchical
monitoring of employees by management may lead to more attendance for fear of being
discovered (Chaudhury amp Hammer 200319 Gauteng Province 201015) A health care
service institution may use Health Information System and Personnel and Salary
Administration System (PERSAL) among others to ease the burden of the monitoring
process All these tools combined are useful in gathering administrative data for
management
29
2104 Visits to facilities
The role of human resource at institutional level is to support and guide management as
well as monitor compliance issues Workplace absenteeism remains a key focus area
because of its impact on the budget of an organisation Unscheduled facility visits are
conducted with the view to audit workplace absenteeism The audit is to be done in line
with the auditor-general or internal risk managementrsquos approach to encourage consistency
A check list that is used is prepared by human resource practitioners and institutions are
familiar with A human resource accounting officer of the institution should be involved
when an audit is done
The institution must have evidence available of sporadic visits to employees who have been
identified as having developed absenteeism patterns with the view to rule out elective
absence The European Foundation (199713) and Munro (200722) state that ill- health is
the main reason for workplace absenteeism Employees who present with ill- health are
generally and frequently more absent from work than the healthy ones The authors also
observe that not all employee assistance programmes aimed at reducing workplace
absenteeism have an effect on the ill-health of the employees which render the
unscheduled visit to the employees vital to see where the caring employer could be of
assistance
2105 Incentive system
According to Buschak et al (199628) the catastrophic model (CAT) caters for major illness
that keeps the employee away from work for extended periods of time This model is similar
to short and long term incapacity sick leave which is catered for by PILIR subsection 73
(DPSA 2009) The managers require special training for successful implementation of the
policy The paid time off model (PTO) has hidden benefits incentives for employees not to
use unnecessary sick days which are then paid for at retirement The research by Lambert
and Camp (20054) compares the Civil Service Retirement System (CSRS) and the Federal
Employees Retirement System (FERS) and showed that in the final analysis and when
novelty wore off workplace absenteeism was not necessarily reduced by the incentive
system
Management should use the strategy to raise awareness about responsible utilisation of sick
leave through workshops about PILIR and the eight week rule It should show the benefits
of good sick leave management when employees are challenged with temporary or
permanent incapacity leave
The use it or lose it approach of the current system reward the abuse of sick leave as it is
viewed as not being beneficial by the employees to act responsible towards the use of sick
leave There is no deterrent not to abuse sick leave in the public sector
30
2106 Team support
Institutions value team effort over individual achievement Operational competencies are
viewed as essential Managers encourage effective communication among team members
motivating others and the development of problem-solving skills Managers through the
team development effort encourage nurturing and transmitting of the institutional culture
Institutional culture refers to a system of shared meaning within an organisation that
determines how employees behave in the workplace Culture and people are like glue that
ensures that institutional standards are upheld Individuals become units that form the
team and conversations at work are encouraged to strengthen team work knowledge
transfer and productivity (Bergdahl 20018-10 Goldsmith amp Morgan 200378 Robbins amp
Decenzo 2001174)
2107 Return-to-work interviews
According to Paton (20101ndash5) a phased return-to-work data management and remote
services are among the approaches employers may use to manage workplace absenteeism
The intervention can involve use of Information Technology systems and telephone
discussions Good absence management is about good people management The return-to-
work interviews provide management with the opportunity to get to know the employee
better and for the employee to substantiate his or her case The employee is afforded
privacy during the sessions which should happen as soon as the employee comes back to
work The key success in this strategy is unthreatening follow ups that are done A multi-
faceted approach is used to get people back to work such as phoning maintaining regular
contact and taking medical advice
The Charted Institute of Personnel Development Annual Report (200835) reported 90 of
public services that use the strategy and 77 use the risk assessment to aid return- to-
work The manager should have private counselling sessions with the employee as soon as
the employee returns to work These sessions provide the employee with the opportunity to
put his or her case across and for the employer to get a first-hand opportunity to asses if the
employee is fit enough to come back to work The employer has to make the employee
aware of the status of the meeting that it is formal and proceedings are recorded The
employer is to keep accurate records of all counselling sessions
31
2108 Employee assistance programme (EAP)
DPSA (PILIR2009) prescribes that the PILIR committee promotes EAP in the workplace and
each institution to establish a committee The PILIR committee consists of a labour relations
officer an EAP practitioner a health practitioner an employee wellness practitioner and
any other relevant practitioner who is co-opted on a needs basis The purpose of the
committee is to manage short and long term incapacity which is sick leave utilised after the
employee has exhausted the 36 days normal sick leave in a three year cycle The short term
incapacity sick leave is of longer than three days and less than 29 days and long term
incapacity is sick leave longer than 29 days The short spells of sick leave become a concern
when there is evidence of a pattern of abuse It is a call for the manager to intervene Every
organisation should provide EAP that is funded by the employer to the employees A health
risk manager is used by the employees who are expected to honour referrals and stay with
the programme until such time that there is evidence of recovery failure by the employee
to accept the programme should attract a disciplinary process
According to Mellor Arnold and Gelade (20098) the amount of support that followers
receive from their transformational leader or co-worker may help reduce levels of absence
by making the workplace a more pleasant place to be and perhaps by helping the person
find solutions to work out family conflict or other problems that produce absence Landstad
et al (20011) suggest that the individuals in the preventive intervention group who were
less than 42 years of age total absence due to sickness decreased The change was obvious
to the cleaners who had a previous history of high absence due to sickness The Charted
Institute of Personnel Development (200836) focused on working-man days lost
management of absenteeism employee well-being and employee rehabilitation The skilled
employees were reported as 12 who were using rehabilitation programmes Yende
(200535) and Fakie (200517) state that EAP despite having been around since 1996 for the
National Department of Health has not actually been managed and utilised to its full extent
whereby if fully utilised would assist in the management of employee workplace
absenteeism
2109 Occupational and safety committee
The focus of this committee is on the provision of a safe working environment by the
employer (RSA Part VI section D 2001) It monitors issues of compliance and adopts the
employee advocacy role The committee consists of all the major stakeholders such as
employee representatives labour representatives that represent employees in the
institution on issues of safety at the workplace In the context of the Gauteng Department
of Health the committee engages with the labour representatives and employer
representatives at bilateral and provincial multi-lateral scheduled meetings
32
According to Du Toit and Van Der Waldt (1998139) the International Labour Organisation
recommends creation and maintaining of a pleasant work environment in order to improve
productivity The environment must stimulate the employee to ensure efficiency and
effectiveness
21010 Review committee
This structure is essential when dealing with incapacity leave It is composed of
management human resource practitioner employee representative labour relations
officer employee wellness and any adhoc person needed in terms of the case under
discussion (DPSA PILIR 2009) The employee reserves the right to lodge a grievance about
the outcome of his incapacity request if it is negative The role of the committee is to
provide a transparent forum reduce hostility against management and to protect the rights
of the employee through involvement of the employee representative
211 CONCLUSION
The literature review that has been consulted explores the workplace absenteeism and its
impact on the institution The employment relationships represent a triangle that consists of
the employer the employee and the industrial environment The relationship is multi-
dimensional and highly regulated with built in mechanisms to handle conflict in the
workplace Conflict is inherent to the employment relationship and structures and
mechanisms such as bargaining councils the Commission for Conciliation Mediation and
Arbitration and Labour Courts are structures for recourse The theory of absenteeism and
employment relationship were explored Management intervention strategies were
explained Controlling absenteeism in the workplace begins with a sound absenteeism
policy that is incorporated into an employee induction programme Communicating and
educating the employees about the absenteeism policy takes the centre stage in the
employment relationship Vigilant monitoring of workplace absenteeism is the responsibility
of the manager closest to the employee such as the supervisor Workplace attendance
problems of employees can be handled using sound judgement keeping accurate
attendance records and administering the policy fairly and consistently
Chapter 3 will collect data which will confirm or negate the literature review that has been
explored in chapter 2
33
CHAPTER 3
METHODOLOGY OF THE RESEARCH
31 INTRODUCTION
Chapter 3 focuses on the methodology used to determine the absenteeism in the four
hospitals of the Gauteng Department of Health The research design and the methodology
that have been used to collect data are discussed below The data are collected in terms of
the characteristics of the stratified random sample such as absenteeism of the different
occupational categories gender age tenure of service race groups and salary
32 RESEARCH DESIGN
A research design is the overall plan for relating the conceptual problem to relevant
empirical research It is a quantitative descriptive research that involves the systematic
collection of numerical information under conditions of considerable control The choice of
the research design influences subsequent research activities such as identifying the target
subjects what data to collect and how they should be collected The research design is a
descriptive survey which is concerned with characteristics of a specific population subject at
a fixed point in time for comparative purposes The focus is on a representative sample of
the relevant population It is concerned with the accuracy of the findings and their
generalisability The survey is used to understand the behaviour of employees with regards
to motivation satisfaction and grievances (Babbie 1992 89 Ghauri et al 199527 60 Brink
199611 Welman et al 200152)
321 Methodology
The Gauteng Department of Health has thirty four hospitals that deliver health care
services The four hospitals that have been targeted for the study of absenteeism are Tara
Moross Centre Hospital in Region A under the Johannesburg Metropolitan Municipality
Germiston Regional Hospital which is in Region B under Ekurhuleni Metropolitan
Municipality ODI District Hospital in Region C under Tshwane Metropolitan Municipality
and George Mukhari Academic Hospital in Region C under Tshwane Metropolitan
Municipality Each hospital is unique in its character in terms of specialisation of health care
delivery service The sample is a stratified random sampling which is composed of various
clearly recognisable non-overlapping sub-populations (strata) that differ from one another
in terms of variables that are a combination of more than one variable such as age sex
income level or educational level The purpose is to ensure that every part of the population
(every stratum) is represented The members of a particular stratum are homogeneous with
the population at large
34
The sample is representative of a population with clearly distinguishable strata with a
greater degree of certainty (Babbie 19927 Brink 1996138 Brynard amp Hanekom 2005 44
Ghauri et al 199578 Welman amp Kruger 200155-56 Polit amp Hungler 199518)
The data were collected in three phases The first phase of data collection was done through
auditing of hard copies of identified personnel files encomprising ten files per hospital and
using the tools in annexure A and B The forty employeesrsquo profiles were accessed through
the Human Resource Information System (HRIM) located in the Gauteng Department of
Health Head Office The respective employeesrsquo profiles were handed over to the human
resource manager in the respective hospital on the morning of the audit for the human
resource practitioner to draw out the hard copy files for auditing The characteristics of the
individuals that were identified for the first phase were males and females as well as
representatives from the different race groups The auditing of the files were for the
complete working life of the employees and not only confined to 2008 calendar year
Registers that are used by human resource administration to control the movement of the
leave form were inspected as evidence of the control system in place The purpose of
auditing the files was to gain insight into how leave in general was captured managed and
controlled by the hospitals
The second phase of data collection were done through structured interviews with four
human resource managers who were directly accountable for management and control of
leave of absence in general in the four hospitals A structured interview provides for a more
organised approach and a more stable basis for assessment of the different candidates
(Erasmus et al 2005250) The structured interview was conducted using the tool in
annexure C Tara Moross Centre Hospital had been functioning without a human resource
manager and the manager that was interviewed had been in the post for three months The
human resource practitioner who was at salary level 8 and acting in the Assistant Directorrsquos
post (manager level 9) was invited to join the manager and be part of the structured
interview ODI District Hospital had three human resource practitioners including the
accounting officer at level 8 in an acting capacity The third phase of data collection was
through the Human Resource Information Management System (HRIM) This system uses
the Personnel Remuneration Administration System (PERSAL) to collect data Data in this
system is categorised in characteristics such as salary level date of appointment
occupational category gender age in units of five race employing hospital employment
status in different sub-categories such as session contract and full-time and the different
types of leave of absence The continuous sick leave of four to five days was excluded from
processing and focus was laid on sporadic days to the start and end of a weekend
35
The research used secondary data in analysing sick leave utilised by full time employees in
the identified hospitals for the period of 1 January to 31 December of 2008 using Persal The
total population sample was four thousand and ten (n=4010)
The research during data collection and analyses used characteristics in the sample such as
occupational groups age tenure of service race gender and salary range from level 1 to
12 The research used past events such as sick leave utilised by employees using secondary
data from Persal falling into the category of historical empirical study The interval scale of
measurement was used in the quantitative research and actual numbers are ordered with
equal measurement between each category (Brink 1996 149 Brynard amp Hanekom 200528-
29 Mouton 200552100170)
33 UNIT OF ANALYSIS
The unit of analysis refers to what or who is studied (Babbie 199292 Brink 1996133) The
unit of analysis in the context of the study refers to observation of work attendance by the
employees of Gauteng Department of Health in the four hospitals The observation deals
with the historical events as employees have already utilised the sick leave in the workplace
The subjects that are studied are the core health care providers such as doctors nurses and
support employees such as allied administration and administration support (Mouton 2005
51-52 Welman et al 2001 52-53)
34 UNIT OF OBSERVATIONS
The observations that are made are of health care employees and support teams in Tara
Moross Centre Hospital Germiston Hospital ODI Hospital and George Mukhari Hospital
and describe the characteristics of a large number of individual people such as sex age
salary range occupational category tenure of service and race in relation to absenteeism in
the workplace The descriptive study and the individual characteristics are aggregated for
the purpose of describing a larger group (Babbie 199292)
35 CONSTRUCT VALIDITY
Construct validity is concerned with the question What construct is the instrument actually
measuring (Brink 1996170) The research used a multi-trait multi-method approach in
construct validity A variety of data collection methods were used such as auditing of forty
hard copy employeesrsquo files in phase one In phase two a structured interview was conducted
with four of the accounting officers in the leave managements The third phase was
collecting of personnel data through the Persal system
36
36 ETHICAL CONSIDERATIONS
Ethical considerations will include amongst other issues such as the protection of the units
of analysis and units of observations from discomfort and harm by not revealing
information which can cause physical emotional spiritual economic social or legal harm
The researcher has to ensure the protection of the subjectsrsquo interests and well-being by
protecting the subjects of observationsrsquo identity through anonymity
Anonymity is achieved when the researcher cannot link a given response with a given
respondent and reporting aggregate data only When data are collected at one sitting and
not over a period of time makes it possible to achieve anonymity as the need for follow up is
eliminated Subjects of observations are selected for reasons directly related to the problem
being studied as the principle of justice Confidentiality is about the researcherrsquos
responsibility to protect all data gathered within the scope of the study and shared only
with people involved in the research (Babbie 1992465ndash466 Brink 199640ndash41 45 Polit amp
Hungler 1995 31-36)
The human resource managers who were interviewed were identified by the hospitals they
represented and therefore remained anonymous to the researcher The interview was part
of the actual audit that was done as part of monitoring and evaluation that was in progress
in the Department of Health following a negative auditor generalrsquos report about
management of leave in general The managers were put at ease as they were given the
checklist afterwards for self-monitoring and for future self-auditing
The data that were collected through Persal identified employees through the Persal
number and kept their identities anonymous The data that were collected through the hard
copy of employeesrsquo files were used to point out areas of concern to the managers and the
files did not leave the office of the manager at the end of the process once more protecting
the identity of the employee
37 CONCLUSION
This chapter dealt with the research design which is the overall plan for relating the
conceptual problem to relevant empirical research The methodology used a stratified
random sample which is composed of various clearly recognisable non-overlapping sub-
populations that differ from one another in terms of variables that are a combination of
more than one variable The data collection was done through three phases The unit of
analysis refers to the persons who are studied The unit of observations are health care
workers and support teams in the four identified hospitals The construct validity used a
multi-trait multi-method approach Ethical considerations include among other issues
protection of the unit of analysis and the unit of observations from discomfort and harm
Chapter 4 discusses the analysis and interpretation of the data gathered in chapter 3
37
CHAPTER 4
INTERPRETATION AND ANALYSIS OF DATA
41 INTRODUCTION
This chapter focuses on the research analysis and interpretation of data gathered on
workplace absenteeism in the Department of Health of the Gauteng Province It seeks to
identify differences or similarities in the leave trends in the 2008 calendar year between the
four identified hospitals chosen for the study in the Municipality of Tshwane Ekurhuleni and
Johannesburg The year 2008 was chosen as a second year in the leave cycle that started in
2007 The type of leave of absence is interpreted as a collective that does not specify the
type of sickness or illness or it being acute or chronic Workplace absenteeism is absence of
the employee at the workplace that is defined by Du Toit and Van Der Waldt (1998139) as
the place that the institution makes available and where officials have to perform their
work It forms part of the internal environment for public administration in the public
service Direct public administration is directly concerned with the rendering of services to
the citizens of the country
Chapter 4 discusses the study of workplace absenteeism in the four identified institutions
namely Tara Moross Centre Hospital Germiston Hospital ODI District Hospital and George
Mukhari Hospital In this research the following factors will be examined the organisational
structure and absenteeism of the different workforce categories such as medical and
nursing professionals administrative staff allied professionals and various categories of the
general assistants workforce and their relation to absenteeism in the institution
42 THE STRUCTURE OF THE ORGANISATION
The Gauteng Province is one of the nine provinces of South Africa In 2005 the auditor-
general conducted an audit of sick leave performance in six national departments and the
Gauteng Province was among those that were omitted from the audit The research focuses
on the Gauteng Department of Health (GDoH) whose core function is to provide health care
services to the people of Gauteng The provision of health care services is labour intensive
and requires large numbers of personnel for effective service delivery The GDoH is serviced
by thirty-four hospitals four of which have been identified for the study of management of
sick leave The employee attendance to work is essential to the achievements of the
Departmental goals The Determination on Leave of Absence determines the leave policy for
public service employees (DPSA 2009) The employees of GDoH represent the staff
component as reflected in the organisational structure of the department
38
The Gauteng Department of Health (GDoH) provides the basic health services to the people
of Gauteng who as internal or out-patients are clients or consumers of the services referred
to as line functions Public administration services rely heavily on support services such as
the personnel department that renders support to line functions that provide the actual
service of patient care Support services are considered as indirect public administration
services and essential in efficient public service delivery Workplace absenteeism has a
negative impact on productivity Employees of the Gauteng Department of Health and their
attendance to work are the focal point of the Province in terms of effective health care
service delivery that is customer focused
Political ideologies as those espoused by labour representatives are part of the external
factors in the workplace environment that consequently have an impact on public
administration and management and workplace attendance by employees (Du Toit amp Van
Der Waldt 1998139170)
FIGURE 41 INTERGRATED ORGANISATIONAL STRUCTURE
(Adapted from Gauteng Department of Health organisational structure 2010)
43 GAUTENG PROVINCIAL GOVERNMENT COMMITMENT TO SERVICE DELIVERY
The Gauteng Provincial Government has made a commitment to its people to account for
the delivery of services as its electoral mandate This commitment will be achieved only
when monitoring and evaluation of its performance is enforced by all Gauteng Department
of Health service providers
39
MEC
HOD
COP
Senior Exec
CD HAST CD Health program
Senior Exc
CD Tshwane
CD JHBWest
CFO
Manage Account
SENIOR CORPORATE
HRM amp LR
GenderampDisability
The Gauteng Governmentrsquos commitment to provision of health care services to all its
citizens is demonstrated by the decentralisation of management of service delivery with the
view to foster accountability increase efficiency and accountability (ANC 199419ndash20
Goldstein 200815) The interpretation of the analysed data takes the sector performance
approach into consideration when the interpretation of absence is across all the
occupational groups for the 2008 calendar year (Gauteng Province 201015)
44 COMPARISON OF HOSPITALSPERMANENT EMPLOYEES
Gauteng employees are counted at 51475 from the Personnel Salary Administration System
(PERSAL) as of March 2008 The population from the four chosen hospitals has been
counted at 4010 reflecting 8 of the total population The different groups of employees
were identified as Africans represented as n=3902 Whites as n=51 Indians as n=14 and
Coloureds as n=43
FIGURE 42 DIFFERENT RACE GROUPS OF THE FOUR HOSPITALS
(Source Compiled by the researcher C S Ndhlovu 2012)
Figure 42 reflects the racial split percentage of the workforce (n=4010) of the hospitals
The population from the four hospitals has been counted as 4010 reflecting 8 (n=51475)
of the total working population for Gauteng Department of Health as from 1 January to 31
December 2008 The different groups of employees were identified as Africans represented
by 973 (n=3902) Whites as 13 (n=51) Indians as 03 (n=14) and Coloureds as 11
(n=43) The George Mukhari Hospital has a female dominated workforce at 739 (n= 2097)
in a total workforce of n=2836
40
Population n=4010
Africans 973
Whites 13
Coloureds 11
Indians 03
TABLE 1 PERMANENT EMPLOYEES OF THE FOUR HOSPITALS
RACE TARA HOSPITAL GERMISTON GEORGE
MUKHARI
ODI TOTAL
Africans 227 367 2836 472 3902
Whites 23 24 3 1 51
Coloureds 5 37 0 1 43
Indians 13 1 0 0 14
Population 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 1 focuses on the distribution of race and the population of the total workforce The
geographical area of the hospital determines the demographics and the tendency of some
groups being poorly represented or totally absent The research focused on permanent
employees of the four hospitals The George Mukhari Hospital employees are reflected as
7079 (n=2839) ODI Hospital as 1182 (n=474) Germiston Hospital as 1069 (n=429)
and Tara Moross Centre Hospital as 668 (n=268) of the total working population Tara
Moross Centre and Germiston Hospitals are located in cosmopolitan areas while the George
Mukhari and the ODI Hospitals are in rural and semirural areas The positioning of the latter
hospitals may account for the high African workforce
41
TABLE 2 COMPARISONS OF NUMBERS OF ADMINISTRATION AND SUPPORT STAFF IN THE
DIFFERENT HOSPITALS
OCCUPATIONAL
GROUP
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Administration
staff
48 60 297 61 466
Administration
support
103 140 719 133 1095
TOTAL 151 200 1016 194 1561
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 2 presents the administration employees and the administration support in the four
hospitals Tara Moross Centre Hospital is represented by 3179 (n=151) of administration
and 6822 (n=103) administration support The George Mukhari Hospital has the highest
representation by the administration support at 7077 (n=1016) The high representation
of the administration support staff at George Mukhari Hospital could be partly because of
the semi-rural environment A semi-rural environment is usually characterised by poverty
which may have a negative influence on opportunities to access education and skills
Doctors and nurses are highly marketable because of the educational levels and skills that
are lucrative and enable this group to be highly mobile geographically (Chaudhury amp
Hammer 20033)
42
TABLE 3 GENDER COMPARISON IN DIFFERENT HOSPITALS
GROUPS HOSPITALS MALE FEMALE POPULATION
Africans Tara 83 144 227
Germiston 52 315 367
George Mukhari 739 2097 2836
ODI 109 363 472
TOTAL 983 2919 3902
Whites Tara 5 18 23
Germiston 5 19 24
George Mukhari 3 0 3
ODI 1 0 1
TOTAL 14 37 51
Indians Tara 1 12 13
Germiston 0 1 1
George Mukhari 0 0 0
ODI 0 0 0
TOTAL 1 13 14
Coloureds Tara 1 4 5
Germiston 6 31 37
George Mukhari 0 0 0
ODI 1 0 1
TOTAL
GRAND TOTAL
8
1006
35
3004
43
4010
(Source Compiled by C S Ndhlovu 2012)
Table 3 focuses on gender distribution in the population of the research represented by
males and females in the different racial groups
43
The geographical area of the hospital determines the demographics and the tendency of
some groups being poorly represented or totally absent The males of the different hospitals
account for 251 (n=1006) while the females account for 749 (n=3004)
The George Mukhari Hospital has a female dominated workforce at 7394 (n=2097) out of
a total workforce of n=2836 White male employees are represented by 011 (n=3) against
the total workforce of the hospital (n=2839) There are no Indians and nor any Coloured
employees African males are represented by 2603 (n=739) The same hospital has no
white female employees no Indians no Coloureds and 7395 (n=2097) African females
The table reflects a predominantly African female workforce The hospital is situated in a
rural setting and this may have an impact on the vast difference in the gender
representation
The Tara Moross Centre and Germiston Hospitals are located in cosmopolitan areas They
have 187 (n=5) and 1117 (n=5) White male employees respectively and 672 (n=18)
and 443 (n=19) female employees respectively Tara Moross Centre Hospital has 4 48
(n=12) female Indian employees while Germiston Hospital has only 024 (n=1) Germiston
Hospital has 723 (n=31) female Coloured employees while Tara Moross Centre has 150
(n=4) The core function of the various hospitals may have influenced the gender
distribution
TABLE 4 COMPARISON OF TENURE OF SERVICE IN RELATION TO ABSENTEEISM IN THE
FOUR HOSPITALS
TENURE IN YEARS DAYS OF ABSENCE PERCENTAGE
1ndash10 4451 30
11ndash20 6577 443
21ndash30 2934 198
31ndash40 878 59
TOTAL 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 4 reflects the level of tenure of the total workforce from 1 year to 40 years of service
Tenure of 11 years to 20 years of service reflects 443 (n=6577) utilisation of leave of
absence and remains the highest rate of absenteeism followed by tenure of 1 to 10 years of
service at a 30 absenteeism rate
44
TABLE 5 COMPARISON OF THE OCCUPATIONAL GROUPS IN THE DIFFERENT HOSPITALS
OCCUPATIONAL
CATEGORIES
TARA GERMISTON GEORGE
MUKHARI
ODI TOTAL
Doctors 12 12 354 19 397
Professional
nurse
47 81 548 109 785
Staff nurse 15 53 358 56 482
Nurse assistant 16 50 308 55 429
Social worker 4 4 8 3 19
Occupational
therapists
4 0 15 1 20
Radiographer 0 3 27 6 36
Clinical
Psychologists
4 0 10 2 16
Physiotherapists 0 1 9 1 11
Dieticians 0 0 5 3 8
Finance 4 11 59 9 83
Speech
therapists
0 0 5 1 6
Pharmacists 2 9 36 5 52
Dentists 0 0 0 3 3
Technicians 2 5 51 6 64
Librarian 1 0 0 0 1
Security 6 0 30 1 37
Administration
and support
151 200 1016 194 1561
TOTAL 268 429 2839 474 4010
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 5 reflects a great difference in terms of number of occupational groups in the four
hospitals
45
The core function and the size of the hospital seems to have a bearing on how many
occupational categories of employees are to be found in that hospital as well as the actual
figures of these categories The George Mukhari Hospital is an academic hospital that trains
medical doctors This hospital has 1247 (n=354) doctors in a staff establishment of
n=2839 Tara Moross Centre has 448 (n=12) in a staff establishment of n=268 Germiston
has 280 (n=12) in a staff establishment of n=429 and ODI District hospital has 401
(n=19) in a staff establishment of n=474 This trend of vast differences in figures
represented by the occupational groups is evident in the category of professional nurses
where George Mukhari Hospital reflects 1931 (n= 548) nurses Tara Moross Centre is
represented by 1754 (n=47) Germiston by 1889 (n=81) and ODI District hospital by
23 (n=109) The impact of absenteeism is pronounced when viewed against the level of
facility capacity in terms of human resources of the core occupational groups
441 The Tara Moross Centre Hospital
Tara Moross Centre Hospital is a speciality psychiatric hospital in Region A with a workforce
of 669 (n=268) of the total workforce (n=4010) The core function of the hospital is
specialised such that some occupational categories are not available in the hospital as part
of the workforce and patients are referred out to other facilities for specialised treatment
Tara Moross Centre Hospital falls under the jurisdiction of the Johannesburg Metropolitan
Municipality
442 The Germiston Hospital
Germiston Hospital is a regional general hospital in Region B with a total permanent staff
establishment of 1070 (n= 429) of the total workforce (n=4010) The hospital falls under
the Ekurhuleni Metropolitan Municipality It does not have occupational therapists clinical
psychologists dieticians speech therapists and dentists in its permanent staff
443 The ODI District Hospital
The ODI District Hospital is in Region C and is in transition due to boundary changes It is
being transferred from the North West Province to the Gauteng Province The hospital is in
a semi-rural area with a staff component of 118 (n=474) of full-time employees (n=4010)
and falls under Tshwane Metropolitan Municipality It is a general district hospital
444 The George Mukhari Hospital
The George Mukhari Hospital is an academic hospital in Region C under Tshwane
Metropolitan Municipality The hospital trains doctors and employs 010 (n=3) White male
employees 26 (n=739) African males and7184 (n=2097) African females out of the
total female workforce (n=2919)
46
This phenomenon may be as a result of the hospital having the highest general assistants
workforce at 2065 (n=586) out of the workforce (n=2839) The George Mukhari Hospital
has the highest number of general assistants out of the four hospitals represented as 25
(n=719) in a total workforce of n=2836 African employees
45 RESEARCH INTERPRETATION
The interpretation of leave of absence is confined to salary level 1 to 12 full time employees
of the Gauteng Department of Health who took leave of absence from the workplace for the
calendar year in 2008 It excludes the contract employees periodic remuneration foreign
employees and permanent employees above salary range 13
The Basic Conditions of Employment Act 75 of 1997 Section 9 (3) (RSA 1997) prescribes
procedures in terms of progressive reduction of the maximum working hours to the goal of
a 40-hour working week and an eight-hour working day Finnemore and Van Rensburg
(2002462) state that the reduction of maximum working hours to 40 hours a week is done
through collective bargaining with due regard to job creation efficiency and health safety
and welfare of employees Du Toit and Van Der Waldt (1998232) use the formula to
aggregate lost working-man hours due to ill health and disability as aggregate lost hours in
the survey period divided by 40 hours in a week and x number of hours in a year A formula
to work out the absenteeism rate by Pierce (2009) is represented as A=BC A= Absenteeism
rate B= Total number of days lost due to absenteeism in a given period C= Total number of
working- man days available in the given period C=D x E D=Total number of employees
planned to work in the given period E=Number of available working days in the given
period
The approach of the research uses the principle of absence from the workplace when due to
work to identify the lost working hours (Pierce 2009 Davey amp Cummings 2009313) The
study applies a retrospective approach
The working-man lost days for the Province in the four hospitals is approached in terms of
lost working -man days simplified refers to the number of days meant to have been worked
but actually not worked due to illness or disability by the employees in a year divided by the
total number of employees of the public sector (PXVI) Barker (200779) argues that a
reduction in working hours increases the hourly cost of production and unit production
unless there is a commensurate increase in productivity This approach has a similar effect
on workplace absenteeism when the workload of those employees who are present
increases as they carry the double load to meet the demands of service delivery The cost of
absence to the Province is expressed as salary expenditure for each day of leave of absence
from the workplace (PSC 2002 xiii Pierce 2009)
47
The salary range is laid down according to Annexure in DPSA Circular 1 of 2008 The Gauteng
Government experienced a cost estimated at R29 million in 2000 and approximately R54
million in 2001 from absenteeism and loss of working time (Parbhoo20031)
The formula that is used in this research to calculate lost man work-hours is collective
working days of absence multiplied by 8 hours in a working day resulting in the total
working hours that are lost This formula can be represented as
Lost days x hours (8) in a working day = lost working hours
As stipulated by the Basic Conditions of Employment Act 75 of 1997 section 9 1(c) 3
TABLE 6 RACES IN RELATION TO ABSENTEEISM
RACE TOTAL DAYS OF ABSENTEEISM PERCENTAGE
Africans 14295 963
Whites 242 16
Coloureds 201 14
Indians 102 07
TOTALS 14840 100
(Source Compiled by the researcher 2012)
Table 6 represents absenteeism in the diverse races in the workplace The absenteeism rate
seems to be proportional to the number of employees The Employment Equity Act 55 of
1998 defines the term ldquoblackrdquo as a generic term which means Africans Coloureds and
Indians The Africans as a race group is represented by 963 (n=14295) of the total
working days lost (n=14840) The high figure of lost working-man days reflects the
demographics of the four hospitals The George Mukhari Hospital is in a rural setting that is
predominantly African populated and employs the highest number of Africans as
represented in table 3 Whites are presented by 16 and not represented in all
occupational categories and salary ranges that could explain the low figures and
percentages associated with working-man days lost Africans constitute the highest number
of employees as well as the highest percentage of working-man days lost Absenteeism
percentage is proportional to the employment figures for this race group The Indian race
group is represented by the lowest figure of employment and lowest percentage of leave of
absence which is proportional to the employment figure
48
TABLE 7 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM
OCCUPATIONAL
GROUPS
TARA GERMISTON ODI GEORGE
MUKHARI
TOTALS
DOCTORS 22 118 5 290 435
PROFESSIONAL NURSE 272 346 20 2459 3097
STAFF NURSE 128 247 13 1568 1956
NURSE-ASSISTANT 150 126 25 1145 1446
FINANCE 0 0 0 386 386
ADMINISTRATION 57 272 20 1923 2272
ADMIN SUPPORT 754 547 163 3784 5248
TOTAL 1383 1656 246 11555 14840
(Source Compiled by C S Ndhlovu 2012)
Table 7 reflects the working-man days lost by the different occupational groups The
doctorsrsquo workload in terms of the annual report for Gauteng Department of Health
(2008951) was 226 as against the target of 227 while the national target was 187
The bed occupancy rate target for the same time was 75 while the actual figure was
653 The annual report interpreted in conjunction with the data of leave of absence for
doctors reflects a negative impact in terms of service delivery and the cost factor to the
department
451 Occupational groups in relation to absenteeism
The multi-group invariance structural model presents different types of occupations and is
used to identify variance in the patterns in terms of occupational groups The model allows
different relationships between variables in different occupations The different
occupational groups are doctors professional nurses and sub-categories administration
staff and administration support staff (Pousette amp Hanse 2002230) According to Gaudine
and Gregory (2010599) absenteeism was a problem among health care workers in
comparison to other employees in other sectors The cornerstone of an efficient health care
service delivery is equity and efficiency which is threatened when employees are not at
work when expected to be (Andrews 199734-35 DPSA 1997)
49
According to the Charted Institute of Personnel Development (200811) the survey that was
conducted found that public sector employees are less likely to be disciplined or dismissed
for reasons of workplace absenteeism
Tables 5 and 6 and 7 reflect the different occupational groups and the level of absenteeism
in the four hospitals of the Gauteng Department of Health
4511 Doctors
Doctors are represented by 10 (n=397) of the total working population (n=4010) The
29 (n=435) indicates the number of working-man days lost in relation to the total
working- man days lost (n=14840) The percentage of working- man days lost in relation to
the total number of full time employees of the four hospitals is reflected as 435 divided by
n=4010 times the percentage which results in 108 (n=435) working-man days lost
multiplied by 8 hours that represent a working day The outcome is n=3480 working-man
hours The cost to the Province is calculated in terms of the salary expenditure as direct and
indirect salary payment for lost working-man hours estimated at 3480 hours at salary level
10 at R217 482 to salary level 12 at R 407745 as well as indirect costs such as replacement
of staff and overtime
The doctorsrsquo workload in terms of Gauteng Province 20089 annual report (2008951)
reflects the doctorrsquos workload as 226 as against the target of 227 while the national
target is reflected as 187 The bed occupancy rate target for the same time is 75 while
the actual target rate is 653 The annual report when interpreted in conjunction with the
data of leave of absence for doctors reflects a negative impact in terms of service delivery
and the cost factor to the Department when considering a loss of n=3480 man hours of
work
Chaudhury and Hammer (200311) found in their research that the doctors presented the
highest absenteeism rate Serneels et al (2008210) argue that absenteeism is rife in the
public sector where employees hold two jobs and is highest among doctors The doctor
absenteeism rate in the research does not stand out as high in comparison with the other
occupational groups The doctor absenteeism rate is 29 when compared to the total
workforce This occupational group is represented by 10 of the total population The
doctorsrsquo absenteeism rate does not seem to be outstandingly high in comparison with the
other occupational groups in relation to the total number of permanent doctors
50
4512 Professional nurses
The professional nursesrsquo absenteeism is reflected as 208 (n=3088) that indicates the
number of working-man days lost in relation to the total working-man days lost (n=14840)
The percentage of working-man days lost in relation to the total number of full time
employees (n=4010) in the four hospitals is reflected as 77 The cost to the Province
translates into direct and indirect salary expenditure which is spread from salary level 4 to
12 at R64 410 to R407 745 in 2008 for the total duration of lost working days
Du Toit and Van Der Waldt (1998232) pointed out a crisis in four other public hospitals in
the Gauteng Province that was caused by budget cuts and shortage of doctors and nurses in
2008 The vacancy rate of 697 in the professional nurse category and the absence rate of
208 in 2008 in the four hospitals seem to point to a lack of adequate human resources for
effective health care delivery The extent of working-man hours lost in the findings of the
research suggest a high rate of absenteeism and not a good reflection of happiness as
suggested in the annual report Professional nurses are second to the administration
support in absenteeism at 208 at a total of (n=785) nurses in the four hospitals with
absenteeism of n=3088 working-man days lost or n=20704 working-man hours lost This
category of employees is classified as skilled to highly skilled at salary range of 4 to 12The
total vacancy rate was at 697 as against the national target at 15 in 2008 with
absenteeism of 208 Madibana (201022) found in the research about absenteeism
among nurses that the high rate of absence had a negative impact in the quality of health
care rendered by nurses
4513 Staff nurses
Staff nurses are reflected in tables 4 and 5 as representing 12 (n=482) of the total working
population (n=4010) The 132 (n=1956) indicates the number of working-man days lost
in relation to the total working-man days lost (n=14840) times the percentage
The percentage of working-man days lost in relation to the total number of full time
employees in the four hospitals is reflected as 488 The cost to the Department is
expressed as direct and indirect salary expenditure for n=15648 working-man hours lost
The impact of leave of absence to health care services and cost to the Department is the
same as the professional nurses as staff nurses are a sub-category of the nursing profession
4514 Nursing assistants
Nursing assistants are reflected in tables 4 and 5 as represented by 107 (n=429) of the
total working population (n=4010) and 97 (n=1446) represent working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The
percentage of working-man days lost is reflected as 36 (n=1446) in relation to the total
number of employees in the four hospitals (n=4010)
51
The cost of leave of absence to the Department is expressed as the salary expenditure at
salary levels 3 to 6 Salary level 3 is at R54 876 salary level 4 is at R64 410 salary level 5 at
R76 194 and salary level 6 is at R94 000 for n=11568 working-man hours lost and staff
replacement and overtime
4515 Finance officers
Finance officers are reflected in tables 5 and 7 as represented by 21 (n=83) of the total
working population (n=4010) and 26 (n=386) indicates the working-man days lost in
relation to the total working-man days lost (n=14840) times the percentage The cost to the
Department is reflected as salary expenditure from salary level 2 at R47 787 to salary level
10 at R217 482 for R2 728 working hours lost The institutions reflected a small number of
this occupational category as permanent employees place them in the category of scarce
skills
4516 Administration staff
The administration staff is represented in tables 2 and 4 and 5 by 116 (n=466) in the total
working population (n=4010) and 153 (n=2272) indicates the working-man hours lost in
relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 567 represent the working-man days lost in relation to the total number of
full time employees in the four hospitals (n=4010) The cost of leave of absence to the
department is reflected as salary expenditure at salary level 4 to 12 Salary 4 at R64 410 to
salary level 12 at R407 745 for 18176 working hours lost
4517 Administration support
The administration support is reflected in tables 2 and 4 and 5 as represented by 273
(n=1095) of the total working population 354 (n=5248) indicates the working-man days
lost in relation to the total working-man days lost (n= 14840) times the percentage The
percentage of 1309 (n=5248) indicates the working-man days lost in relation to the total
number of employees in the four hospitals (n=4010) The total cost to the Department is
reflected as salary expenditure at salary level 2 to 3 at a cost of R47 787 to R54 879 for
41984 working -man hours lost
The highest percentage of absenteeism in the different categories of employees in the four
hospitals is identified in the administration support category It is this category that falls into
the salary range of 2 and 3 which is classified in the Gauteng Province 20089 annual report
(20089325) as lower skilled employees This category represents the highest single
category of employees for the Department at n=1095
52
The impact to the core service delivery employees that require support from administration
staff would seem to be negative as the absence of employees from the workplace would
hamper the smooth workflow Barker (2007214-224) acknowledges the decline in the flow-
through rate in the school education higher grades namely Grade 11 and Grade 12 and
ventures to give possible reasons for this phenomenon The Gauteng Department of Health
as a possible employer has attracted a high percentage of the labourer category as
identified in table 3 totalling n=1095 which is 273 of the total workforce Pousette and
Hanse (2002230-231) suggest that the employeersquos authority to make decisions in his or her
job and the breadth of use of skills used by the employees at work become different aspects
of control with human service at work This approach suggests that reduced job autonomy is
associated with higher sickness absence The administrative support employees are involved
in mechanical or manual labour that predisposes them to musculo-skeletal problems The
work environment could have a negative impact to the high absenteeism rate in this group
FIGURE 43 OCCUPATIONAL GROUPS IN RELATION TO ABSENTEEISM AS REPRESENTED BY
THE HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 43 reflects the absenteeism rate of the different occupational groups as represented
by the hospitals The George Mukhari Hospital contributes 7079 to the total workforce
and contributes about 779 to absenteeism The absenteeism rate does seem to be low at
7 when considered in the light of the contribution The question that maybe be raised is
whether the relative low absenteeism is indicative of high morale of a happy workforce
53
ODI 17
TARA 93
GERMISTON 111
GEORGE MUKHARI 779
Germiston Hospital contributes 106 to the total workforce and the absenteeism is
reflected as 111 which seems to be above its contribution to the workforce by 1 The
professional nurse and the administration category present with the highest rate of
absenteeism in this hospital The Tara Moross Centre Hospital contributes 67 of the total
workforce and the absenteeism rate is at 93 which is 26 higher The administration
support and professional nurses present with the highest level of absenteeism in this
hospital The ODI Hospital contributes 6 to the total workforce and the absenteeism rate
which seems to be low is reflected as 17 This hospital has no access to the Persal system
and is dependent to a neighbouring hospital It is highly probable that the information is not
accurate
Allen (1984 331) found that union members might be absent more frequently from the
workplace than non-members because they face smaller penalties for absenteeism The
Charted Institute of Personnel and Development (CIPD) (200811) claim that the 2006
survey of absence management portrays the public sector employees as less likely to be
dismissed for reasons of workplace absenteeism
TABLE 8 SALARY RANGE IN RELATION TO ABSENTEEISM (SALARY RANGE 1-12)
SALARY RANGE DAYS OF ABSENCE PERCENTAGE
1-2 178 12
3-4 5235 353
5-6 2044 138
7-8 5139 346
9-10 1878 126
11-12 366 25
TOTAL 14840 100
(Source Compile by the researcher C S Ndhlovu 2012)
Table 8 reflects the salary range with the lowest working days lost as salary level 1 to 2 This
is proportional to the number of employees The highest absenteeism rate has been noted
in the salary range at level 3 to 4 while salary ranges at level 11 to 12 reflected a low rate of
absenteeism The latter salary range is at middle management level and the responsibility
the employees carry may be responsible for the low absenteeism rate Rogers and Hertin
(1993219) noted that the level of education seem to have influenced the use of sick leave
where the lower level category employees were found to have higher level of absenteeism
than higher educated employees
54
TABLE 9 AGE IN RELATION TO ABSENTEEISM
AGE IN YEARS DAYS OF ABSENCE PERCENTAGE
20 to 24 16 010
25 to 29 405 272
30 to 34 733 493
35 to 39 1582 1066
40 to 44 2676 1803
45 to 49 3318 2235
50 to 54 3046 2052
55 to 59 2235 1506
60 to 64 829 558
TOTAL 14840 9999(100)
(Source Compiled by the researcher C S Ndhlovu 2012)
Table 9 reflects age in relation to absenteeism in the four hospitals The age group at 20 to
24 years reflects the lowest figure in working-man days lost at 010 (n=16 days)
Reday-Mulvey (200579) observed that employees over 45 years take marginally fewer short
sick leave days per year than those under 45years
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 to 55 years
as middle -age and shows this group as presenting with a high incapacity leave usage In the
research the age group 45 to 49 years presented with 2235 (n=3318) working-man days
lost and is the highest figure of absenteeism in all age groups The age group at 20 to 24
years is reflected as the lowest absenteeism rate in working-man days at 010 and this
could be related to the number of employees in this age group
According to Reday-Mulvey (20057988) and the Canadian Nurses Association (20065)
employees that are over 45 years take marginally fewer short sick leave periods but take
slightly longer sick days per year than those under 45 years and reflect higher absenteeism
in the age group above 50 years
55
Weeks (200454) found that employees at the age group represented by 51 to 60 years
show less absence which may be because of ill health retirement benefits The age 31 to 40
and 41 to 50 years show higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full time jobs and suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee In the study the age group 55 to 59 years show a decline in absenteeism in
comparison to 50 to 54 while age 60 to 64 shows the lowest rate
The aging employee has been found to expose the institutions to high levels of absenteeism
through a higher probability of becoming incapacitated for longer periods (Ferguson et al
200138) and the current research have pointed differently Rogers and Hertin (1993219)
found a significant correlation between the use of sick leave and age suggesting employees
with advanced age used more sick leave in comparison with the younger employees The
current socio-economic culture encourages retirement from active employment at the age
of 65 years and the research adopted that approach as a cut off point for employment
(Nichols amp Evangelisti 2001285)
TABLE 10 GENDER IN RELATION TO ABSENTEEISM
GENDER TOTAL
NUMBER
DAYS OF
ABSENCE
PERCENTAGE
Males 1006 2490 168
Females 3004 12350 832
Total 4010 14840 100
(Source Compiled by C S Ndhlovu 2012)
Table 10 reflects gender in relation to absenteeism The duration of working-man days lost
is higher in female employees at 8325 (n=12350) and is represented by 749 (n=3004) in
relation to the total number of employees in the four hospitals (n=4010) as represented in
table 3 The male employees employed by the Department are reflected as absent from
work by 1680 (n=1006) and represented as 251 in relation to the total number of
employees in the four hospitals (n=4010)
The Public Service Commission (PSC 200222) found that more males took sick leave than
females except for the age group of 16 to 19 years QUALSA (200923) noted that females
had the highest number of incapacity applications in comparison to their male counterparts
Qualsa attributed this pattern to the fact that female employees constitute a higher
percentage of the employee population within the Gauteng Department of Health
56
Roger and Hertin (1993222) noted that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees could have an
impact on the high number of absenteeism reflected by the women
452 Race in relation to absenteeism
The working population of the four hospitals is represented by four race groups such as
Africans Whites Coloureds and Indians
4521 Africans
Africans represent 973 (n=3902) of the total working population (n=4010) and 963
(n=14295) indicates the working-man days lost in relation to the total working-man days
lost (n= 14840) times the percentage 3565 (n= 14295) reflects the working-man days
lost in relation to the total number of employees in the four hospitals (n=4010) The 14295
working-man days lost are multiplied by 8 hours that represent a day and translates into
963 (n=114360) working-man hours lost The cost to the Department is translated as
salary expenditure for n=114360 workingndashman hours lost and the indirect cost of staff
replacement and overtime Africans constitute the highest number of employees as well as
the highest percentage of working-man hours lost Absenteeism percentage is proportional
to the employment figures for this race group
4522 Whites
Whites are represented as 13 (n=51) of the total workforce (n=4010) and 16 (n=242)
represent the working-man days lost in relation to the total working-man days lost
(n=14840) times percentage 61 (n=242) represent working- man days lost in relation to
the total number of employees in the four hospitals The 232 working-man hours lost are
multiplied by 8 hours that represent a working- man day that translates into 16 (n=1856)
working-man hours lost The cost to the Department is represented as salary expenditure of
(n=1856) working-man hours lost that is paid to the unproductive employees This race
group of employees is not represented in all occupational categories and salary ranges
which may explain the low figures and percentages associated with working-man days lost
(n=242) The demographics of the different hospitals may contribute to the low
representation of this group in the total workforce
4523 Coloureds
Coloureds are reflected as 11 (n=43) of the total workforce (n=4010) 14 (n=201)
represent working- man days lost in relation to the total working- man days lost (n=14840)
5 (n=201) indicates working- man days lost in relation to the total number of employees in
the four hospitals (n=4010)
57
The cost to the department is represented as salary expenditure for n=1608 working-man
hours that are lost This race group is represented in three of the four hospitals and not in
all categories and salary ranges which may explain the low representation and
absenteeism
4524 Indians
Indians represent 03 (n=14) of the total workforce (n=4010) in table 6 07 (n=102)
represent working- man days lost in relation to the total working- man days lost (n= 14840)
times percentage 25 (n=102) indicates working- man days lost in relation to the total
number of employees in the four hospitals (n=4010) The 102 working- man days lost are
multiplied by 8 hours that represent a working-man day and translates into 07 (n=816)
working- man hours lost The cost to the Department is expressed as salary expenditure
paid to the unproductive employees for duration of (n=816) working-man hours lost This
race group is not represented in two of the four hospitals in some occupational categories
and salary ranges The Indian race group is represented by the lowest figure of employment
and lowest percentage of leave of absence which is proportional to the employment figure
FIGURE 44 RACES IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 44 reflects the different races in relation to absenteeism The Africans as a race
group is represented by 963 of working-man days lost (n=14840) The high figure of lost
working-man days reflects the demographics of the four hospitals
58
14840 DAYS
(100)
Africans 963
whites 16
coloureds 14
Indians 07
The George Mukhari Hospital is in a semi-rural setting that is predominantly African
populated and employs the highest number of Africans as represented in table 1 (n=2836)
Whites are presented by 16 absenteeism rate and not represented in all occupational
categories and salary ranges which could explain the low figures and percentages associated
with lost working days The absenteeism rate for Indians is represented as 07 and
Coloureds as 14
The Africans as a race group constitute the highest number of employees as well as the
highest percentage of working days lost Absenteeism percentage is proportional to the
employment figures for this race group The Indian race group is represented by the lowest
figure of employment and lowest percentage of leave of absence which is proportional to
the employment figure The South African Survey Millennium (1999-200028) reflected the
African males in 1998 as 354 and females as 348 the Coloured males as 39 and
females as 46 Indian males as 39 and females as 15 and White males as 83 and
females as 94 There has been no significant change in the race group representation in
the working population of the four hospitals
453 Tenure in relation to absenteeism
Tenure in years is grouped in units of ten (10) Tenure in 1 to 10 years 11 to 20 years 21 to
30 years 31 to 40 years of all occupational groups are represented in figure 27 as the total
leave of absence utilised by the full-time employees of different occupational groups in
terms of tenure which translates into n=14840 working-man days lost The lowest hours lost
is at tenure 31 to 40 years of service which is reflected as 59 (n=878) working- man days
lost The highest working-man days lost is at tenure of service of 11 to 20 years reflected as
443 (n= 6577) working- man days lost Tenure of service of 1 to 10 years reflects 30
(n=4451) working-man days lost and tenure of years at 21 to 30 years reflects 198 (n=
2934) working- man days lost
Rogers and Hertin (1993222) express tenure as work experience in years that is viewed as a
predictor of employee productivity where seniority has been found to be inversely related to
absenteeism in terms of frequency and total number of work days lost The Canadian Nurses
Association (20065) suggests that job tenure increases with age as illustrated in their
research where nurses were found to have both job tenure of 20 years or more and are over
45 years of age In the research the tenure of 31 years to 40 years presented with the lowest
absenteeism rate in agreement with Rogers and Hertin (1993222)
59
FIGURE 45 TENURE OF SERVICE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 45 reflects the total leave of absence from tenure of 1 year to 40 years The PERSAL
system reflected 40 years as representing more or less 64 years of age and 65 years is the
cut off point for full time employees in the system The lowest working- man days lost is at
tenure of 31 to 40 years of service which is reflected as 590 and represents the older
employee in general The highest working- man days lost is reflected at tenure of 11 to 20
which is presented as 4430 representing the younger employee This is an area of concern
as table 5 reflects professional nursesrsquo absenteeism rate at 208 and administration
support staff at 356 and is possible that the absenteeism rate of the two occupational
categories may be a bigger contributor to the high absenteeism rate reflected in the tenure
of 11 years to 20 years
454 Salary range in relation to absenteeism
The salary range is interpreted in the study as a salary broad band that is represented in
table 9 and ranges from level 1 to 12 Rogers and Hertin (1993 219) claim that the level of
education does seem to have a bearing on the salary range use of sick leave where the
lower level category employees were found to have higher levels of absenteeism than the
higher educated employee The Human Resource Development Strategy (Gauteng Province
200815214) claims that the chances of entering into a higher income bracket in South
Africa rises noticeably after people have twelve years of education The ages 20 to 24 years
are greatly affected by this assumption
60
0
20
40
60
Tenure 1-10Tenure 11-20
Tenure 21-30Tenure 31-40
30 4430
1980
590
Tenure
FIGURE 46 SALARY RANGE IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 46 above reflects the salary range from 1 to 12 in relation to working- man days lost
as salary range 1 to 2 as n=178 working-man days lost which converts to 12 The highest
absenteeism rate has been noted in the salary range at level 3 to 4 at 3530 (n=5235)
working-man days lost while salary ranges at level 7 to 8 is reflected as the second highest
level of absenteeism at 346 (n=5139) lost working-man days
Salary range at 5 to 6 is reflected as the third highest in absenteeism at 138 (n=2044) lost
working-man days Salary range 9 to 10 is regarded as the entry point to middle
management and is reflected as the fourth highest at 126 (n=1878) working-man days
lost Salary range at 11 to 12 is regarded as middle management entrusted with high levels
of authority and accountability This group is reflected as losing 25 (n=366) working- man
days lost which is considered to be a reasonable low level of absenteeism
455 Age of full time employees in relation to absenteeism
The QUALSA REPORT (200917) reflected the age group of 45 years to 49 years as presenting
with a high number of short temporary claims It is in this age group that a number of
applications were declined by QUALSA which suggest that the health risk manager found in
their assessment the claims to be invalid The report defines the age group of 35 years to 55
years as middle-age and shows this group as presenting with a high incapacity leave usage
In the research the age group of 45 years to 49 years is represented with 2235 (n=3318)
working- man days lost and is the highest figure of absenteeism in all age groups
61
178
5235
2044
5139
1878
366
0
1000
2000
3000
4000
5000
6000
Salary range1-2
Salary range3-4
Salary range5-6
Salary range7-8
Salary range9-10
Salary range11-12
DAYS OF ABSENTEEISM
Reday-Mulvey (20057988) and Canadian Nurses Association (20065) observed that
employees over 45 years take marginally fewer short sick leave periods but take slightly
longer sick days per year than those under 45 years and reflect higher absenteeism in the
age group above 50 years
Weeks (200454) claims that the age group at 51years to 60 years show less absence may be
because of ill health retirement benefits The age group of 31 years to 40 years and 41years
to 50 years show a higher absenteeism than other groups Reday-Mulvey (200579)
postulates that absenteeism is very high in the age group above 50 years as age advances
and changes in abilities set in to those employees who hold full-time jobs He suggests that
part-time work reduces absenteeism which increases with age and the cost of the senior
employee The aging employee has been found to expose the institutions to high levels of
absenteeism through higher probability of becoming incapacitated for longer periods
(Ferguson et al 200138)
Rogers and Hertin (1993219) claim that there is a significant correlation between the use of
sick leave and age suggesting employees with advanced age comparatively used more sick
leave in comparison with the younger employees The current socio-economic culture
encourages retirement from active employment at the age of 65years and the research
adopted that approach as a cut off point for employment (Nichols amp Evangelisti 2001285)
FIGURE 47 AGE IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
(Source Compiled by C S Ndhlovu 2012)
Figure 47 reflects the number of working-man days lost by full-time employees through
absenteeism related to a specific age
62
16
405
733
1582
2676
3318
3046
2235
829
0
500
1000
1500
2000
2500
3000
3500
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Days of absence
Days of absence
Age groups are organised in units of 5 to be consistent with the Personnel and Salary
Administration System (PERSAL) The age group at 20 years to 24 years reflects the lowest
percentage of absenteeism at 010 (n=16) working-man days lost and the age group of 45
years to 49 years reflect the highest days of absenteeism at 2235 (n=3318)
456 Gender in relation to absenteeism
The females employed in the Department of the four hospitals are represented as 749
(n=3004) in relation to the total number of employees in the four hospitals (n=4010) and
lost 8320 (n=12350) working-man days This absenteeism rate is considered high
considering that not every female employee may have used sick leave The male employees
employed in the Department are represented by 25 (n=1006) of the total workforce
(n=4010) and lost 168 (n=2490) working-man days The findings suggest that males
utilised fewer days of sick leave considering the fact that not every male employee may
have utilised sick leave for the duration of the study
The Public Service Commission (PSC 200222) claims that more males took sick leave than
females except for the age group of 16 years to 19 years QUALSA (200923) noted that
females had the highest number of incapacity applications compared to their male
counterparts Qualsa attributed this pattern to the fact that female employees constitute a
higher percentage of the employee population within the Gauteng Department of Health
Rogers and Hertin (1993222) argue that in terms of gender women are viewed as absent
from their workplace more than men The total number of female employees may have an
impact on the high rate of absenteeism
63
FIGURE 48 GENDER IN RELATION TO ABSENTEEISM
(Source Compiled by C S Ndhlovu 2012)
Figure 48 reflects gender in relation to absenteeism The females employed by the
department in the four hospitals are reflected as absent from work at a rate of 8320
(n=12350) working-man days and represented by 749 (n=3004) in relation to the total
number of employees (n=4010) in the four hospitals The male employees employed by the
Department are reflected as absent from work at 1680 (n=2490) and represented as
251 (n=1004) in relation to the total number of employees in the four hospitals
(n=4010)
457 Week days in relation to occupational groups
Table 11 reflects the trends in terms of days of the week that show high utilisation by the
different occupational groups Mondays Fridays and Thursdays reflect a high utilisation rate
by the employees suggesting a pattern of high absenteeism rate over weekends
Professional nurses and sub-categories and the administration support group reflected the
highest absenteeism over the weekends
64
1680
8320
000
1000
2000
3000
4000
5000
6000
7000
8000
9000
Males Females
GENDER ABSENCE
TABLE 11 WEEK DAYS IN RELATION TO ABSENTEEISM IN THE FOUR HOSPITALS
OCCUPATIONAL
CATEGORY
MONDAY TUESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Doctors 18 8 13 17 0 0
Professional
Nurse
135 86 94 137 0 0
Staff Nurse 52 38 56 65 2 0
Nursing
Assistant
62 27 34 45 2 0
Administration
Staff
64 38 58 73 1 0
Administration
support
252 147 98 126 26 15
Finance officer 17 4 8 16 0 0
TOTAL 600(4) 348(23) 361(24) 479(32) 31(02) 15(010)
(Source Compiled by C S Ndhlovu 2012)
Table 11 reflects the pattern of how the different occupational groups utilised sick leave on
the different days of the week It illustrates the days that sick leave started on each day of
the week The largest number of incidences of sick leave commence on Monday the first
working day of the week as reflected by 4 (n=600) of the days of the weekend Fridays are
the second highest days of absenteeism represented by 32 (n=479) Tuesdays and
Thursday are almost the same in utilisation as reflected by 23 and 24 respectively
Professional nursesrsquo absenteeism was pronounced on Mondays as 2250 (n=135) and
Fridays as 2861 (n=137) a trend that shows possible long weekend absenteeism
The administration support staff has been reflected as mostly absent on Mondays 42
(n=252 days) and Fridays 2631 (n=126 days) The administration support reflected the
highest days of absenteeism on Saturday (n=26) and Sunday (n=15) The Canadian Nurses
Association (CNA) (2006) focused on seasonal pattern of absenteeism in the different
categories in the different hospitals The PSC (2002) report identified a trend by provincial
employees of using sick leave to extend their weekends The research considered working-
man days lost in terms of days of absence as in accordance with evidence of a medical
certificate Administration support is the only group that seem to have utilised Saturdays
for sick leave 8387 (n=26) and Sundays 100 (n=15) days
65
TABLE 12 CONTRIBUTIONS TO ABSENTEEISM BY THE FOUR HOSPITALS
INSTITUTIONAL
CONTRIBUTION
TARA MOROSS
CENTRE
GERMISTON ODI GEORGE
MUKHARI
TOTAL
Contribution to
Sample
668 1070 1182 7080 100
Contribution to
Absenteeism
842 1177 165 7816 100
(Compiled by C S Ndhlovu 2012)
Table 12 reflects the contribution of each hospital to absenteeism Tara Moross Centre
Hospital contributed 67 to the sample and the absence rate is higher than the
contribution at 84 The Germiston Hospital contributed 107 to the sample and the
absenteeism rate is higher at 117 The George Mukhari Hospital contributed 708 to the
sample and absenteeism rate is at 782 and ODI Hospital contributed 118 and
absenteeism rate is at 17 The latter hospital has no computers at The reflection of the
status of absenteeism is likely to be inaccurate The George Mukhari Hospital has the
highest contribution to the sample yet leave of absenteeism is tolerable It raises questions
as to what should be the contributory factor to the leave of absence status in this hospital
46 CONCLUSION
Chapter 4 presented the analysed data in terms of the characteristics as determined in the
stratified random sampling The characteristics and their association with absenteeism have
been presented such as occupational categories age gender tenure of service and race
The research identified which days of the week were utilised for sick leave absence The
contribution of each hospital to absenteeism was identified and a brief overview of each
hospital was presented
Chapter 5 presents the findings conclusion and recommendation of the research
66
CHAPTER 5
FINDINGS CONCLUSIONS AND RECOMMENDATIONS
51 INTRODUCTION
Chapter 1 provides a general introduction to the research It included the background and
motivation for the research that provides the context the problem statement and the
significance of the research The key concepts are defined The research design the method
of data collection the sampling method data analysis and interpretation and limitations to
the research are explained in this chapter
Chapter 2 considers the theoretical foundations concepts characteristics theories
approaches and classifications of workplace absenteeism The discussions on the conceptual
framework of absenteeism predictors of absenteeism and various models of absenteeism
are presented Measures to control workplace absenteeism and the impact of absenteeism
in an institution and management intervention strategies in workplace absenteeism were
discussed
Chapter 3 describes the research design and the different aspects of the research methods
that were applied to the research The chapter explains the various data collection
techniques that are used unit of analysis units of observations construct validity and
ethical considerations
Chapter 4 provides the organisational structure of the Gauteng Department of Health
comparisons of hospital employees different race groups of the four hospitals gender
comparisons in different hospitals and comparisons of the different occupational groups It
provides a short description of the target hospitals The research interpretation is discussed
in terms of the different occupational groups and absenteeism different races and
absenteeism tenure of service and absenteeism salary range and absenteeism age in
relation to absenteeism and gender in relation to absenteeism The trends of week days of
absenteeism in the four hospitals and contributions to absenteeism by the four hospitals are
presented
Chapter 5 explains a synthesis of the study and evaluation of workplace absenteeism The
findings of the research and recommendations are discussed
52 FINDINGS
The findings of the research reflect doctors as represented by 108 in the total workforce
(n=4010) have an incidence of 29 (n=435) of the total work-man days lost (n= 14840) by
the employees in the four hospitals translating to a total of n=3480 working hours lost
67
The working-time lost is considered against the doctorsrsquo workload of 226 in contrast to the
target of as 227 while the national target was 187 The bed occupancy rate target was 75
while the actual figure was 653 The annual report when it is interpreted in conjunction
with the sick leave absence of doctors at 29 shows no negative impact on the workload in
terms of service delivery The negative impact is mainly on the cost factor to the state as the
doctorrsquos salary level is from salary level 10 at a cost of R217482 to salary level 12 at
R407745 (Gauteng Province annual report 2008951) Serneels et al (2008210) claim that
absenteeism occurs primarily in the public sector associated with people who hold two jobs
and that is highest and more frequent amongst doctors The findings of the research of
absence of 29 with a contribution of 2 to the sample are in disagreement with the
Serneels et al findings
Professional nurses represent 196 (n=785) of the total workforce (n=4010) The
workplace absenteeism is represented as 77 (n=3088) of the total workforce (n=4010)
translating into 21 of working-man days that are lost (n=14840) The absenteeism rate
appears to be very high given the fact that nurses by virtue of their numbers are the
backbone of health care service delivery (DPSA 2009) The Gauteng Province annual report
of 2008951 reflects the total vacancy rate of nurses at 697 as against the national target
of 15 The absenteeism rate of 77 is very high when compared with the total vacancy
rate and 19 contribution to the sample Staff nurses are a sub-category of the nursing
profession and the impact of their absence to service delivery is the same as the
professional nurses The findings of the study reflect staff nurses representing 12 (n=482)
of the total working force (n=4010) The absenteeism from staff nurses is reflected as 13
(n=1956) of the total working-man days lost (n=14840) The absenteeism rate does appear
to be high when considering the contribution of 13 to the absence rate by a sample of 12
to the total working-man days lost Nursing assistants are a sub-category of the nursing
profession that is reflected as 107 (n=429) of the total number of employees (n=4010)
and represent 97 (n=1445) of the total working-man days lost (n=14840) This absence
rate is considered as high when compared with the total number of employees
The nursing occupational group considered collectively contributed to absenteeism at the
workplace at 997 which is extremely high Davey and Cummings (2009312-313) claim
that frontline nursesrsquo absenteeism contribute to discontinuity of patient care decreased
staff morale and high cost to health care The high absenteeism rate has a negative impact
on health care service delivery
The findings of the research reflect administration staff as 116 (n=466) of the total
number of employees (n=4010) represented by 154 (n=2286 days) of the total working-
man days lost (n=14840) Administration support is at salary level 1 to 2 with exceptional
instances of salary level 3 to 4
68
Administration support staff is reflected as 273 (n=1095) of the total workforce (n=
4010) represented by 356 (n=5289 days) of the total working-man days lost (n=14840)
translating to n=42312 lost working-man hours
The administration staff viewed collectively contributed 51 to absenteeism which is very
high with the support staff reflected as 356 Rogers and Hertin (1993219) claim that the
level of education seem to have influenced the use of sick leave where the lower skilled
category of employees were found to have higher levels of absenteeism than higher
educated or skilled employees The findings of the research reflect the administration
support staff to be in line with the Roger and Hertin findings
The Gauteng Department of Health has a limited number of finance officers causing them to
be a scarce skill occupational group The finance officers represent 2 (n=83) of the total
workforce (n=4010) The working-man days lost are reflected as 23 (n=341) of the total
working-man days lost (n=14840) The total absence at 23 is higher than the actual
contribution to the sample at 2
The age group of 45 years to 49 years reflects the highest absenteeism rate at 224
(n=3318) the age group at 50 years to 54 years is reflected as 205 absenteeism The age
group 40 years to 44 years reflected as 18 absent from the workplace The age group of 55
years to 59 years is reflected as 15 absenteeism Employees of advanced age used more
sick leave in comparison with the younger employees This phenomenon could be attributed
to the ageing process of the body and the onset of incapacity Absenteeism has been found
to be higher in employees who are over 50 years of age and the phenomenon is attributed
to age and changing abilities that increase when work is performed full- time The findings
of the research reflect the age group over 50 years at 205 and reflect the highest
absenteeism rate at age 45 years to 49 years as 224 (McGoldrick amp Arrowsmith 200184
MINTRAC 20093 Nichols amp Evangelisti 2001285 Reday-Mulvey 200579-194) According to
Ferguson et al (200138) the aging employee presents with high levels of absenteeism
through higher probabilities of becoming disabled for longer periods The findings of the
study reflect absenteeism of the age group of 55 years to 59 years at 15 which is the
lowest in the age groups The Canadian Nurses Association in (20065) noted a reduction in
workplace absenteeism rate among nurses who are less than 45 years of age and an
increase in the absenteeism rate among nurses above 55 years of age According to Bangali
(20043-4) the falling rate of the older employee age group could be influenced by the
practice of early retirement or voluntary severance which was used in the 1990s as a
method of restructuring in institutions Rogers and Hertin (1993219) claim employees with
advanced age used more sick leave in comparison with the younger employees
69
The group at tenure 11 to 20 years presented with the highest level of absenteeism at
443 The employee at tenure of 21 to 30 years presented with 198 of absenteeism rate
while the employees at 1 to 10 years presented with the rate of 30 The findings of the
research reflected tenure of 31 to 40 years to have presented with the lowest absenteeism
rate at 59 (n=878 days) This low absenteeism rate could be ascribed to the fact that
numbers of employees are reduced in this group or could also be commitment to their jobs
or could have higher ambition levels to aspire to higher posts
Van Der Westhuizen (2006136) and Rogers and Hertin (1993222) express tenure as work
experience that may be viewed as a predictor of employee productivity where seniority has
been found to be inversely related to absenteeism in terms of frequency and total number
of working-man days lost The public service employees enjoy security of tenure which may
contribute to the unacceptably high levels of absenteeism (Andrews 1997221ndash222
MINTRAC 20093)
The findings of the research reflect females as 75 of the total workforce (n=4010)
represented by 832 (n=12350) of the total working-man days lost (n=14840) The males
represent 25 of the total workforce (n=4010) and are reflected as absent at 168
(n=2490) of the total days of absence (n=14840)The absenteeism rate is very high for
females in this research Rogers and Hertin (199322) and Van Der Westhuizen (2006136)
suggest that women are absent from workplace more than men are Landstad et al (20011)
found that women cleaners who received preventive personnel support depicted a
reduction in absenteeism rate Hoxsey (2010562) claims that although women presented
with a high score of job satisfaction than men they maintained higher levels of
absenteeism MINTRAC (20094ndash8) found that gender moderates the age turnover
relationship Women are more likely to remain in their jobs the older they get than men do
The findings of the research reflect Africans as represented by 26 of the working
population and utilised 963 of the total working-man days lost due to sick leave It is
possible that the overall number of Africans influenced what seems to be a high level of
absenteeism at 963 Whites represented 03 of the working population and
absenteeism is reflected as 16 of the total working-man days lost Coloureds are
represented by 03 of the working-man population and absenteeism was recorded as 14
of the working-man days lost The Indians are represented by 01 of the total working
population and are reflected as 07 of the working-man days lost
The findings of the research reflect the salary range at level 11 to 12 utilised 25 working-
man days for sick leave salary level 7 to 8 which is the supervisory level utilised 346
working-man days lost salary level 3 to 4 which is the entry level of skilled workers utilised
353 working-man days lost The findings suggest management used fewer days of sick
leave in comparison to the supervisory level and entry skilled worker level
70
This can be ascribed to the fact that they are ultimately responsible for the institutionrsquos
effectiveness and productivity
The George Mukhari Hospital contributed 708 to the sample and reflected 771
absenteeism which is relatively low in comparison to the size of the contribution It could be
that processes and procedures of controlling leave of absence are in place The Tara Moross
Centre Hospital contributed 67 to the sample and reflected 93 absenteeism rate that is
high by 26
Professional nurses reflected a trend of high absence over the weekend including
Thursdays This could be a sign of burn out and extending the period of rest from possible
high workloads resulting from high vacancy rates (Gauteng Province annual report 20089)
Nyathi (200059) and the PSC (2002) found that employees are absent from work because
they want to prolong the weekend
53 CONCLUSIONS
The absenteeism rate is very high for females in this research The aging employee presents
with high levels of absenteeism through higher probabilities of becoming disabled for longer
periods The use it or lose it approach of the current system rewards the abuse of sick leave
as it is viewed as not being beneficial by the employees to act responsibly towards the use
of sick leave
The vacancy rate of 697 in the professional nurse category and the absence rate of 208
in 2008 in the four hospitals can only suggest inadequate levels of human resource for
effective efficient quality health care services at a high cost to the Province The nurses
may not be aware of the actual absenteeism or they under-estimate it The combination of
high registered nurse absenteeism and high patient load could be a strong factor in lowering
health care delivery
Professional nurses and administration support staff have absented themselves from the
workplace predominantly on Mondays and Fridays It could be for various reasons ranging
from feelings of burn out to extending the weekend
The percentage of working-man days lost in relation to the total number of full-time
employees in the four hospitals is reflected as 488 which is very high as there is no
deterrent not to abuse sick leave in the public sector The findings of the research found a
significant correlation between the occupation and use of sick leave age and the use of sick
leave gender and use of sick leave and tenure and use of sick leave
71
The biggest hospital George Mukhari presented the lowest rate of absenteeism for its size
and complexity which reflects an empowered management The Tara Moross Centre
Hospital is the smallest hospital highly specialised and presented with high rate of
absenteeism for its contribution which may be a reflection on the skills of its management
or the type of health care service that is offered by the institution
The international norm of absenteeism is 3 The research established the absence rate at
488 The Gauteng Department of Health is held at ransom by the five trade unions it has
signed agreements with and that makes it difficult for managers to manage absenteeism
The practise of Gauteng Department of Health Head office to remove managers from
institutions when there is a labour unrest exacerbates the problem of managing
institutions
The findings of the research could not establish a representative reflection of race and
absenteeism as Indians Coloured and Whites were not represented in some institutionsrsquo
demographics
54 RECOMMENDATIONS
The White Paper on Transforming Public Service holds management responsible for
delivering specific levels of services and for obtaining value for money in wider utilising of
resources This strategy is to be translated into action The Gauteng Department of Health
should probably benefit by adopting the total absence management philosophy by
cultivating a culture that is not tolerant of high levels of absenteeism through building it in
as a key performance area of the performance of all managers and all employees The
current performance dimension system should lay explicit emphasis on this aspect
The re-engagement of knowledge based and professional retirees at reasonable
remuneration levels to reward their expertise may assist in reviving good work ethics by
mentoring the new and generally young recruits The retired professionals are currently
resisting the call for re-employment on a contract basis at entry level
The Gauteng Department of Health can encourage flexitime in terms of 58 or 68 to allow
the mature employee to remain within the system with the view to share their knowledge
and skills with the young employees who may be highly qualified but lack experience This
approach may deal with the need for adequate human resources for health care delivery at
reduced cost as two employees on flexitime basis can occupy one full-time employeersquos post
Managers should use the return-to-work counselling strategy to solicit feedback from the
employee about the actual absenteeism The counselling should be on a one-to-one basis
This approach may raise self-awareness to the employees in terms of the impact of the
employeersquos absence frothed workplace
72
Currently this intervention strategy is not adequately utilised for fear of confrontation with
labour representatives
Managers should have attendance policies in place effectively communicate policies to
employees adhere to policies and procedures and use absence control strategies
consistently This approach will minimise the feeling of injustice by employees Currently the
human resource unit is challenged by a high staff turnover due to promotions from the
human resource area a situation that creates a vacuum and lack of continuity weakening
the process of empowering line managers by human resource practitioners This high staff
turnover may be controlled through upgrading of the human resource salaries as the
salaries fall out of the occupation service dispensation (OSD)
Managers in the public service are expected to be responsible and accountable for their
portfolios including management of leave of absence and should not shift it to the human
resource unit as is currently the practice It should be possible to charge a manager as an
accomplice for failing to manage the absence of employees where there is no evidence of
corrective remedial action where it has been warranted The researcher takes cognisance of
the fact that the public service is highly unionised and this approach may trigger industrial
action
The employer needs to revive on the job in-service education and training as a way of
imparting institutional values such as attendance at the workplace in partnership with
recognised labour representatives through bilateral and multilateral forums and through
institutional skills development committee which should be representative of all
stakeholders with the view to promote stability in the workplace and indirectly enhance
productivity and reduce workplace absenteeism Currently the bilateral multilateral and
skills development committees are inactive in the institutions that were targeted and
management seems to be intimidated by the militant labour representatives
High levels of absenteeism among some occupational groups do suggest a need for an active
employee assistance programmes at all hospitals Employee wellness committees are
currently inactive There is a sporadic intervention approach at some institutions where
PILIR Committees are active Employee assistance programmes should be budgeted for as a
standing on-going programme in all hospitals There is a need for a thorough research as to
why absenteeism remains high in the public service and focus on absenteeism broadly
73
BIBLIOGRAPHY
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African National Congress
Allen SG 1984 Trade union absenteeism and exit-voice Industrial and Labour Relations
Review 37 (3 April)
Auriacombe CJ 2001 Guidelines for drawing up research proposals and preparing
thesesdissertations Pretoria University of South Africa
Amin S Das J amp Goldstein M (eds) 2008 Are you being serviced Newtools measuring
service delivery Washington DC The International Bank for Reconstruction and
DevelopmentThe World Bank
Andrews Y 1997 The personnel function University of Pretoria Kagiso Tertiary
Babbie E 1992The practice of social research6th edition California Wadsworth
Bamford L Klein amp Engelbrecht B 1999 How to monitor and address absenteeism in
district hospitals for sub-district support initiative for sub-district support Cape Town
KWIK-SKWIZ 25 Press Gang
Bangali A 2004 Are older workers genuine assets for economy Strategies and possibilities
for effective use of their human resource potentialTuebingen Eberhard Karls University
Barker F2007The South African labour market theory and practice5th edition Pretoria
Van Schaik
Bendix S 2000 Industrial relations in South Africa4th revised edition Lansdowne Juta
Bergdahl M 2001 How-Malrt minimises business with HR practices Human Resource
Development Gauteng College Regional Academy Leadership Journal 6
Breetzke A 2009 Managing absenteeism Available at httpwwwIrnetworkcoza
(Accessed on 05082009)
Brink H 1996 Fundamentals of research methodology for health care professionals
Kenwyn Juta
74
Brynard PA amp Hanekom SX 2005 Introduction to research in Public Administration and
related academic disciplines Pretoria Van Schaik
Burton JP Lee TW amp Holtom BC 2002The influence of motivation to attend and
organizational commitment on different types of absence of behavioursJournal of
Managerial Issues14 (2)
Buschak M Craven C amp Ledman R 1996 Managing absenteeism for productivity SAM
Advanced Management Journal6 (1)
Camp S amp Lambert EG 2005 The influence of organizational incentives on absenteeism
Sick leave use among correctional workers Available on
httpwwweascnoaagov(Accessed on22052009)
Canadian Nurses Association 2006 Trends in illness and injury ndashrelated absenteeism and
overtime among publicly employed registered nurses Canadian Nurses Association Ottawa
Available on httpwwwcna-aiicca (Accessed on 30032009)
Chaudhury Namp Hammer JS 2003Ghost doctors absenteeism in Bangladeshi health
facilitiesWorld Bank Policy Research Working Paper 3065 May Available
onhttpecoworldbankorg(Accessed on 10072011)
Charted Institute of Personnel and Development 2008Absence managementAnnual survey
report Charted Institute of Personnel and Development July Reference 4513 Available at
httpwwwcipdcouk (Accessed on 10072011)
Cloete JJ 2004South African public administration and management2ndimpression
Pretoria Van Schaik
Clark RL 2007The emergence of phased retirement economic implications and policy
concerns Ontario John Deutsch Institute for the study of economic policy
Dagmara S 2000Whorsquos minding the hospitals Absenteeism soars HampHN Hospitals amp
Health Networks 74 (4) April 14ndash143 Available at httpwwwoasisunisaacza(Accessed on
20072011)
Davey MMamp Cummings G 2009 Predictors of nurse absenteeism in hospitals a
systematic review Journal of Nursing Management 17 312ndash330 Available on httpO-
webebscohostcomoasisunisaacza (Accessed on 30072011)
Department for Public Service and Administration1997White paper on transforming public
service delivery Pretoria Public Service Commission
75
Department of Public Service and Administration 2007 Determination on working time in
the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Determination of leave of absence
in the Public Service Pretoria National Office
Department of Public Service and Administration 2009 Policy and procedures on incapacity
leave for ill-health retirement (PILIR)Pretoria National Office
De Wit P 2006 Reasons for absenteeism in the Department of Defence Pretoria Tshwane
University of Technology
Du Toit Damp Van Der Waldt G 1998 Public management grassroots Cape Town Juta
Du Toit D Knipe A Van Niekerk D Van Der Waldt Gamp Doyle M 2001Service
excellence in governance Cape Town Heinemann
Du Toit D Bosch D Woolfrey D Godfrey S Rossouw T Christie S Cooper C Giles
G amp Bosch C 2003Labour relations law a comprehensive guide4thedition Durban
LexisNexis Butterworths
Erasmus B Swanepoel B Schenk H Van der Westhuizen EJamp Wessels JS 2005 South
African human resource management for the public service Pretoria Juta
European Foundation for the Improvement of Living and Working Conditions
(EFILWC)1997Preventing absenteeism at the workplace Ireland Office for Official
Publication on the European Committee
Fakie SA 2005Report on the Auditor-General on a performance audit of the management
of sick leave benefits at certain national and provincial departments Pretoria Department
Public Service and Administration (DPSA)
Ferguson T D Muedder Kamp Fitzgerald R M2001 The case of total absence
management and integrated benefitsHuman Resource Planning24 (3)
Finnemore M amp Van Rensburg R 2002 Contemporary labour relations Johannesburg
LexisNexis
Gaudine A amp Gregory C2010The accuracy of nursesrsquo estimates of their absenteeism
Journal of Nursing Management 18599ndash605
Gauteng Province 2007 Human Resource Development Strategy for Gauteng for Gauteng
maximizing human capital for shared growth Pretoria Government Printers
76
Gauteng Province 20089 Annual report Pretoria Government Printers
Gauteng Province 2010 Monitoring and Evaluation Policy FrameworkGauteng Provincial
Government Office of the Premier
Ghauri P Gronhaug Kamp Kristianslund I 1995 Research methods in business studies
England Prentice-Hall
Goldsmith Mamp Morgan H 2003 ldquoLeadership is a contact sport The ldquofollow up factorrdquo in
management development The 5th Annual Global Learning SummitResearched and
organised by SALVO 20ndash24Feb
Goldstein M2008Why measure service delivery Are you being serviced New tools for
measuring service deliveryEdited byAmin S Das Jamp Goldstein MWashington DCThe
International Bank for Reconstruction and DevelopmentThe World Bank
Griep RH Rotenberg L Chor D Toivanen SampLandsbergis P2010Beyond simple
approaches to studying the association between work characteristics and absenteeism
Combining the DCS and ERI modelsRoutledge Taylor amp Francis GroupWork ampStress 24 (2
April-June)179ndash195Available athttpwwwinformaworldcom (Accessed on 20072011)
Grogan J 2003 Workplace law 7 th edition Lansdowne Juta
Grogan J 2005 Dismissal discrimination and unfair labour practices Lansdowne Juta
Hirschfield RR Schmitt LPamp Bedeian GA2002 Job-content perceptions performance-
reward expectancies and absenteeism among low-wage public-sector clerical employees
Journal of Business and Psychology 16(4) Human Sciences Press Available on
rhirschfterryugaed(Accessed on 30032009)
Hoxsey D2010Are happy employees healthy employees Researching the effects of
employee engagement on absenteeismCanadian Public Administration53 (4) p551-
571Canada The Institute of Public Administration of Canada
Jacobs EJamp Roodt G 2011 The mediating effect of knowledge sharing between
organisational culture and turnover intentions of professional nursesSouth African Journal
of Information Management
Jankowitz E 1991Terminating for absenteeism practical labour management Rivonia IR
Data Publication 1(10)
Keese M2006 Live longer work longerDELSA Newsletter OECD Available at
httpwwwoecdorgelsemployment(Accessed on 10072011)
77
Lambert EG Camp SD Edwards Camp Saylor WG 2005 Here today gone tomorrow
back again the next day absenteeism and its antecedents among Federal Correctional
staffWashington DC Ohio
Landstad B Vinberg S Ivergard TT Gelin G ampEkholm J2001Change in pattern of
absenteeism as a result of workplace intervention for personnel support Ergonomics
001401391544 (1)
LexisNexis 2006Labour Law Reports July 1994ndashDec2006CumulativeIndex Durban
LexisNexis
LexisNexis 2007 Legislation and strategyLexisNexis (9)Durban Butterworths Available at
httpwwwmylexisnexiscoza (Accessed on 15072011)
Madibana LF 2010 Factors influencing absenteeism amongst professional nurses in
London Pretoria University of South Africa
Markussen S Rogeberg OJ amp Gaure S 2009 The anatomy of absenteeism IZA
Discussion Paper Series No 4240 June Bonn Institute for the Study of Labor
McCormick ET amp Ilgen D1985 Industrial and organizational psychology 8th edition New
Jersey Prentice-Hall
McGoldrick E amp Arrowsmith JJ 2001Discrimination by age the organizational response
Ageism in work and employment Edited by Glover IampMohamed Sterling Management
SeriesEngland University of Sterling
Mellor N Arnold Jamp Gelade G2009The effects of transformational leadership on
employees in four of UK public sector organisations Health and Safety Laboratory for the
Health and Safety Executive UK RR648 Research Report
MINTRAC 2009 Literature review on labour turnover and retention Available at
strategieswwwmintraccom (Accessed on 14042009)
Mouton J2005How to succeed in your Masterrsquos and Doctoral studies a South African guide
and resource book Pretoria Van Schaik
Munro L 2007 Absenteeism and presenteeism possible causes and solutions The South
African Radiographer45(1) Available onhttpsorsaorgza(Accessed on 10072011)
Nel PS Gerber PD Van Dyk PS Haasbroek GD Schultz HB Sono TampWerner A
2001 Human resource management5th edition New York Oxford
Nel PS Kirsten M Swanepoel BJ Erasmus BJampPoisant P 2008South African
employment relations theory and practice6th edition Pretoria Van Schaik
78
Nichols AampEvangelisti W2001 Fitness for work the effect of aging and the benefits of
exerciseSterling management series ageism in work and employmentEdited by Glover
LampMohamed B England University of Sterling
Nyathi MN 2000Factors contributing to absenteeism among nurses a management
perspective Pretoria University of South Africa
Patrick MN 2001Positive psychological functioning among civil servantsPretoria
University of South Africa
Paton N2010 Long-term absence hand in hand Occupational Health Reed Business
Information UK Reed Elsevier Available athttpebscohostcomoasisunisaacza
(Accessed on 10072011)
Parbhoo S2003 Why worry about absenteeism in the workplace CCMA PublicationCCMA
Mail July
Pierce K2009 The impact of absenteeism in the public service in the context of GEMS
Pretoria GEMS Government Employees Medical Scheme [lsquoslrsquo]
Public Service and Co-ordinating Bargaining Council (PSCBC) 2000Resolution 72000
Polit DF amp Hungler BP 1995 Nursing research principles and methods Philadelphia
Lippincott
Pousette A amp Hanse JJ 2002Job characteristics as predictors of ill-health and sickness
absenteeism in different occupational types-a multigroup structural equation modelling
approachNational Institute for working life TaylorampFrancisSweden Goteborg Available on
httpwwwtandfcouk (Accessed on 10072011)
Public Service Commission2002Sick leave trends in the Public Service Pretoria Public
Service Commission
QUALSA Report 2009Policy procedure incapacity leave and ill-health retirement Steering
Committee QUALSA [rsquoslrsquo]
Reday-Mulvey G 2005Working beyond 60 key policies and practices in Europe New York
Palgrave Macmillan
Republic of South Africa 1995 Labour Relations Act 66 of 1995
Republic of South Africa 1997 Basic Conditions of Employment Act 75 of 1997
Republic of South Africa 2001 Public Service Regulation 2001
79
Republic of South Africa 2011 ldquoTowardsquality care for the patientrdquo National Core
Standards for Health Establishments in South Africa Pretoria Government Printers
Robbins SP amp Decenzo DA 2001 Fundamentals of management essential concepts and
applicationsNew Jersey Prentice Hall
Robbins SP Odendaal A amp Roodt G2004Organizationalbehaviour Global Southern
perspective 5th impression Cape Town Pearson
Rogers RE amp Hertin SR 1993Patterns of absenteeism among government employees
Public Personnel Management22 (2)Available at httpwwwquestiacom (Accessed on
10012009)
Serneels P Lindelow MampLievens T2008Qualitative research to prepare quantitative
analysis absenteeism among health workers in two African countriesAre you being
serviced New tools for measuring service deliveryEdited by Amin S Das
JampGoldsteinM2008 The International Bank for Reconstruction and DevelopmentThe
World Bank for Reconstruction and Development Washington D C The World Bank
Slabbert JA amp Swanepoel BJ 2001Introduction to employment relations
managementDurban Butterworths
South African Survey Millennium1999-2000 Johannesburg South African Institute of Race
Relations
Steers RMamp Rhodes SR 1978Major influences on employee attendance a process
model Journal of Applied Psychology63 (4)391-407
Oi-ling S2002Experience before and throughout the nursing careerPredictors of job
satisfaction and absenteeism in two samples of Hong Kong nursesJournal of Advanced
Nursing 40 (2)218ndash229 Available on httpwwwebscohostcomoasisunisaacza
(Accessed on 10072011)
Todd C2001Contract of employment Claremont Siber Ink
Tonya TW2001Minimizing absenteeism in the workplace strategies for nurse managers
Nursing Economics19 (2 MarApril) 53 3 Available at httpwwwoasisunisaacza
(Accessed on 14012009)
Tustin C 1994Industrial relations a psychological approach1st edition Halfway House
Southern Publishers
80
Unruh Jamp Strickland M2007 Nurse absenteeism and workload Negative effect on
restraint use incident reports and mortality JANORIGINAL RESEARCH Journal compilation
Florida Blackwell
Van der Westhuizen C 2006Work related attitudes as predictors of employee absenteeism
Pretoria University of South Africa
Venter R 2003 Labour relations in South AfricaRevised edition Cape Town Oxford
University Press
Viviane IJ 2011Absenteeism among women workers in industry85 IntrsquoLab Rev 248
(1962) Available at httpwwwHeinonlineorg(Accessed on 18052012)
Weeks KL 2004 Development and initial characteristics of a comprehensive survey on
workplace absenteeism Logan Utah State University Available on
httpwwwoasiscomunisaacza(Accessed on 14012009)
Welman JC amp Kruger SJ2001Research methodology for the business and administrative
sciences 2nd edition New York Oxford
Yende PM 2005 Utilising employee assistance programmes to reduce absenteeism in the
workplace JohannesburgUniversity of Johannesburg
81
ANNEXURES A B C
ANNEXURE A
PROCESS EVALUATION QUESTION COMPLIANCE
YESNO
ACTION PLAN
Retention and Reward -
leave
1 Are there complete and
accurate Z 1(Leave application
forms) forms on file
2 Have all application forms been
approved stamped and
registered
3 Have all forms been captured
on the Persal with the following
requirements
Supporting documents
A 10 day compulsory leave
processed within the annual
leave cycle Determination of
Leave
4 The remaining days are utilized
6 months from the end of the
leave cycle
5 Are there unutilized leave days
6 Has there been adequate
checking of leave reasons
Leave credits
Adherence to leave categories
(i)Normal ( ii) Incapacity
(iii) Injury on duty (iv) Maternity
(v)Adoption (vi) Family
responsibility
(vii) Office bearersshop stewards
and Casual Employees
7 Have work reasons been
provided for leave days
(Source Compiled by C S Ndhlovu 2012)
82
ANNEXURE B
Retention and
reward ndashsick leave
Evaluation Question Compliance YesNo Action Plan
1 Are there medical
certificates that have been
submitted to all medical
claims with the following
Specific illness stated
Supporting documents on
file
2 Has the 8 week rule for
36 days in a 3 year cycle
been adhered to
3 Are there complete
medical certificates for 3
days or more sick leave
days for normal sick leave
4 Are all other leave days
above 3 days utilized after
36 days treated as
temporary incapacity
leave
5 Are temporary
incapacity leave forms
submitted within 5 working
days after the first day of
absence
6Is there a register for
temporary incapacity
leave for 1 to 29 days lead
time for reporting leave
applications
7 Has the employer
approveddeclined the
leave application within 30
working days of receipt
(Source Compiled by C S Ndhlovu 2012)
83
ANNEXURE C
CHECK LIST
Is there a leave register in place for all leave applications
1 Is leave approved prior to the employee proceeding on leave
2 Area attendance registers maintained and up to date
3 Are periodic audits for leave carried out
4 Is there evidence of GSSCrsquos approval on leave applications
5 Are leave forms accurately captured on Persal
6 Are leave forms accurately completed by applicants
7 Is movement of leave forms monitored between the GSSC and institutions
8 How is rejected leave application dealt with
(Source Compiled by C S Ndhlovu 2012)
84
